* First name * Last name * E-Mail Address * Mobile Number +91 * Password The password must contain minimum of 8 characters. * Confirm Password Must be same with password. * Date of Birth * Sex -Choose- Male Female * PAN No. * Upload PAN Image (jpg/png) * Fees (INR) * Image Profile (jpg/png) * Specialty -Choose- Cardiologist Cardiac Surgeon Neurologist Neurosurgery Orthopedist Gynecologist Gastroenterologist Oncologist Surgical Oncologist Radiation Oncology Pediatrician Urologist Nephrologist Immunology Surgery Psychology & Mental Health ENT / Otorhinolaryngology Thoracic Surgery Ophthalmology * Year of Medical Degree -Choose- 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 * Doctor Status -Choose- AIIMS Resident / Ex Resident Ex AIIMS Doctor * Overall Tenure at AIIMS From -Choose- 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 To -Choose- 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 * Last Position Held at AIIMS * Department * Current Hospital / Clinics Associated With +Add Current Hospital / Clinics Associated With Current Hospital / Clinics Associated With Medical registration number with supporting documents * IMC/DMC No. * Upload Document (pdf/jpg) Bank Account Details * Bank Name * Bank Account No. * Bank IFSC Code * Upload Cancelled Cheque Photo (jpg/png) Register
