This document is a doctor registration form for a website that allows doctors to create profiles. It requests contact information, personal details, address, professional information like degrees and experience, and asks to upload photos. Upon completing the form, doctors can add clinic and certificate images, assign themselves to clinics, and create schedules.

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