COVIDline.in Doctor Registration Form
This form is for those doctors who want to do their bit to help India fight the COVID-19 crisis. If you are a registered medical practitioner then please fill this form, we will shortly get in touch with you.
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The country you are living in
e.g., Australia, USA, France, India, etc.
Please mention your highest medical degree
e.g., MBBS, MD, DM (Gastro), M.Ch., etc.
WhatsApp number (with your country code)
e.g., +49 987654321.....
Name of the medical institution you are associated with.
Please mention the name of the institution and your profile link (if available), or mention Private if you are an independent medical practitioner.
Commitment (in hours)
1 hour on the day you want to serve
2 hour on the day you want to serve
3 hour on the day you want to serve
4 hour on the day you want to serve
6 hour on the day you want to serve
8 hour on the day you want to serve
Days in a week you want to serve
Please select the days in a weak you are willing to serve.
Time Slot (Preferably in IST)
Please mention the time slot you are willing to serve.
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