Clinical Helpline for COVID-19 | Volunteer Form
Hello,

Thank you for your interest in joining Clinical Helpline!

1. Kindly fill in the form below.

2. Our team will screen your application and, if successful, will reach out to you via email with further instructions.

We appreciate your understanding in order to provide quality service during this time of crisis. For any inquries, feedback, or concerns, please write in to clinicalhelplineindia@gmail.com.

Sincerely,
Clinical Helpline Team
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I have a Degree in: *
My Degree is registered in *
Kindly indicate which State's Medical/Dental/Nursing Council you are registered with.
My Registration Number *
Kindly share your Medical Council of India/State Medical Council/State Nursing Council Registration Number as per the previous question.
Name *
Email ID *
Phone No. *
Kindly give an Indian phone number here
Your preferred time *
If you are not able to commit for the full time slot, select other and share your preferred timing.
Your preferred Language *
Please tick as many languages you are comfortable using in a clinical setting.
Required
Name of Referee *
Kindly give us the name of a registered healthcare professional who can vouch for you.
Contact Details of Referee *
Kindly give us a phone number with which we can reach your Referee.
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