Doctors, Request you to fill the form.
Please provide your details for the free KMES App to increase your patient-base and serve your patients better
Your Name ?
Your Mobile Number ?
A mobile number is required if you want to get the app via Whatsapp or SMS link
Your Email (if any) ?
Please enter email if you haven't entered your mobile number
Highest Medical Qualification?
Specialization (if any)
Home Address or Locality
Please enter only Locality if you are not comfortable to enter your address
Chamber Address/Locality and Timing
If you visit multiple chambers, please enter all the Chamber locality/Timings
What is your average fee at Chamber?
Would you like to go for a patient's home visit near to your home or chamber (obviously, if and when you are available)?
Yes, but I don’t want to visit at the time of emergency
What will be your average fee for a Home visit near your home/chamber ?
Any comments/ suggestion you want to share with us
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