Inquira - Register

Select Profession

First name

Last name

Date of Birth

Email Address

Mobile Number

Address

Specialization

Years of Experience

Qualification

Name of Organisation

Organisation Address

MR Name

MR Code

Assigned Territory

Select Date & Time

Place of Registration

Hiring Purpose:

Recovery Medical Opinion

Legal Certification/Medical Reports

Tele-Consultation (if any)

Third Party Panel Services

Other

Hiring Type:

Part Time

Case Based

Retainer

Per Assignment

Upload Medical Registration Certificate

Upload Photo Identity (Aadhar/PAN)

Upload Clinic Proof/Visiting Card

Please Identify With Live Photo Verfication.

Note: Please Click a clear Photo, photo should not be in dark, face should be clear, no glasses and face should point to the camera.