Pre-Conception and Pre-Natal Diagnostic Techniques

Name Of The Applicant

*

Select District

*

Sub Division

*

Upload Applicant Photo

*

(Allowed format JPG,PNG only)

Upload Applicant Sign

*

(Allowed format JPG,PNG only)

Address

Applicant Email

*

Applicant Mobile

*

Apply Date

*

Centre Name

*

Centre Address

*

Tick If Centre Name Is Same As Applicant Name

Tick If Centre Address Is Same As Applicant Address

Note: To add the doctor, fill all the details of the doctor like name, qualification, attachment and then click on the Save Doctor Details Button

Name

*

Upload Photo (Allowed format JPG,PNG only)

Doctor Affidavit

*

(Allowed format PDF only)

Is PG Degree/Diploma endorsed from Delhi Medical Council (DMC) Yes No

Qualification

*

Delhi Medical Council (DMC) Registration No.

*

Delhi Medical Council (DMC) Certificate

*

(Allowed format PDF only)

MBBS Degree
Yes No

Upload MBBS degree (Allowed format PDF only)

PG dgree/Diploma added in your DMC registration
Yes No

Delhi Medical Council (PG DMC) registration No

*

Delhi Medical Council (PG DMC) certificate (Allowed format PDF only)

PG Degree/Diploma
Yes No

PG Degree/Diploma

PG Degree/Diploma (Allowed format PDF only)

PG Degree/Diploma in Radiology/UltraSonography/Image Scanning
Yes No

Experience/Training in Radiology/UltraSonography/Image Scanning
Yes No

Equipment Name

Machine No

Make

Model

Status

Machine Type

Center Registration (Form A)

Note: To add the doctor, fill all the details of the doctor like name, qualification, attachment and then click on the Save Doctor Details Button