Doctor Registration

Join our network by filling out the form below.

Personal Information

First Name

Last Name

Gender

Date of Birth

District

Contact Information

Phone Number

Password

Qualifications

Doctor Type

Designation

Educational Information

Degree Name

Specialty

Name of Institue

Country

Passing Year

Duration

Upload passing certificate

Click to upload (PDF, JPG, PNG)

Exprience

Institute/Hospital

Designation

Specialist Department

From

Consultation Fees & Discount

Regular Consultation

Discount Amount

Discount Start

Discount End

Follow Up

Follow Up Duration (months)

New Pateint Discount

Discount Start

Discount End

Follow Up Pateint Discount

Discount Start

Discount End

Identification

NID or Passport

NID or Passport Number

Upload Front Side of ID Card

Click to upload (PDF, JPG, PNG)

BMDC Number

Upload BMDC Document

Click to upload (PDF, JPG, PNG)

Please review all information before submitting. Ensure all required fields are filled and documents are uploaded.