Doctor Registration Form for www.doctorsinuae.com

1. www.doctorsinuae.com
DOCTOR REGISTRATION FORM
Account Information
Email*:
Username*:
Password*:
PreferredLanguage*:(foremail andcommunicationEnglishorArabic)
*MUST BE FILLED
Doctor Personal Information
Title*:
FirstName*:
Middle Name:
Last Name*:
Gender*
*MUST BE FILLED
BirthDate:
Photo:
• Profile Photo(wesuggesttogive ussame photo)
• Photosof Certificates
• Photosof Facilities/clinics
Contact Information
Work Phone
Work Mobile Phone
Phone:
Fax:
Social Networks
FacebookLink:
TwitterLink:
YouTube Link:
InstagramLink:

2. www.doctorsinuae.com
Address Information
Address:*
Address(line 2):
City:*
ZipCode:*
Country:
State/Province:
*MUST BE FILLED
Professional Information
Degree:*
Additional Degree:
License Number*:
Education:
Experience:*
ResidencyTraining:
Hospital Affiliations:
Board Certifications:
Awardsand Publications:
LanguagesSpoken:
InsurancesAccepted:
*MUST BE FILLED
REGISTRATION FEATURES
Images:AddClinic,Certificates, Others(Max 4Image free)
Assigndoctorto clinics(Max 2 clinicsFree)
Create Schedulesand AddTimeoff
AddSpecialties