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Email ID(email@mail.com)*

Specialization*

Experience(Only In Number)*

Qualification*

Registration No.*

Registration Year*

Registered Council*

Last Obtained Degree

Degree Year

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Followup Count

Consultation Type*

In Clinic

Tele

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Payment Details

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Account Name

IFSC Code

Bank Name

Paytm Number

Profile Image

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Clinic Details

Clinic Name(If found select from list)*

Contact Number

Type*

Clinic

Hospital

Speciality*

Recommendations

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Address

Address*

Country*

State*

City*

Locality

Zipcode

Clinic Image

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Opd Timings Schedule

Appointment Duration

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Session 1:

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