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APPLY FOR Doctors Registration Program

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We invite you to join us on our journey.

We are currently in the process of building our membership system.

Please use the form to register your interest and we will keep you up to date with progress.

You will also be added to our regular newsletter mailing list.

Thank you,
Team IHA

Join us and be part of our member team

Name
Name (First name, middle name, last name) *

Number of years as Dr. *

Mobile Number *

Email Address *

Gender *

Female

Male

Transgender

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Address Line 1

Address Line 2

Country *

State *

City/Taluka/Mandal/Tehsil *

Pincode *