IHMA

1/4741, Eranjipalam P.O., Kozhikode - 673 006, Kerala (+91) 978 945 5653 ihmaofficial@gmail.com

New Doctors Registration Form

MEDICAL DESIGNATION

Full Name

MEDICAL QUALIFICATION

MEDICAL REGISTRATION NUMBER

MEDICAL REGISTRATION UNIVERSITY

MEDICAL REGISTRATION STATE

MEDICAL REGISTRATION COUNCIL

Full Address

State

City

Pincode

Town/Taluka

(Whatsap Enabled)

Valid Adhar NO.

Valid E-Mail ID

Website Link/Url

Year Of Practice

I would like to receive updates from IHMA National via Email/WhatsApp

I CONSENT TO SHARE MY DETAILS WITH IHMA TECH TEAM.

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1/4741, Eranjipalam P.O., Kozhikode - 673 006, Kerala

ihmaofficial@gmail.com

(+91) 978 945 5653

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