Doctor Onboarding

Thank you for your interest with Capsic Care. Would request you to spare few minutes and fill in the following details to complete your onboarding process.

Personal Information

Full Name *

Medical Registration Number (with Year) *

Mobile Number *

Email ID *

Assistant / Appointment Phone Number (if any)

Consultation Fees (₹) *

Professional Information

Specialization *

Years of Experience *

Degree / Qualifications *

Current Designation

You would like to see your Degree-Designation as:

Practice & Telemedicine Details

Attached Hospital(s) / Clinic(s) with address and phone numbers

Available Telemedicine Days & Timings

Telemedicine Consultation Fee (₹)

Additional Info & Documents

Languages Spoken

Any Additional / Important Information you would like to provide:

Documents to Attach (Xerox copies to be provided to our team)

Check the documents you have ready for our team.

Passport-size PhotographUpdated Medical Registration CertificateDegree / Qualification Certificates (if available)Visiting Card

Declaration

I hereby confirm that the information provided above is true and accurate to the best of my knowledge. I authorize Capsic Care to use these details for professional onboarding, appointment management, telemedicine services, and promotional activities related to my practice.

Doctor's Signature (Type Full Name) *

Date *