1 Doctor details Full name * Mobile number * 10 digits, starting 6 to 9 Email address * e.g. name@example.com Address line * City * State * Select a state Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal Andaman and Nicobar Islands Chandigarh Dadra and Nagar Haveli and Daman and Diu Delhi Jammu and Kashmir Ladakh Lakshadweep Puducherry Pincode * 6 digits Registration council * Select your council National Medical Commission (NMC) Medical Council of India (MCI) — pre-2020 registration Andhra Pradesh Medical Council Assam Medical Council Bihar Medical Council Chhattisgarh Medical Council Delhi Medical Council Goa Medical Council Gujarat Medical Council Haryana Medical Council Himachal Pradesh Medical Council Jammu and Kashmir Medical Council Jharkhand Medical Council Karnataka Medical Council Madhya Pradesh Medical Council Maharashtra Medical Council Odisha Council of Medical Registration Punjab Medical Council Rajasthan Medical Council Tamil Nadu Medical Council Telangana State Medical Council Travancore–Cochin Medical Council (Kerala) Uttar Pradesh Medical Council Uttarakhand Medical Council West Bengal Medical Council Central Council of Indian Medicine (CCIM) — AYUSH National Commission for Homoeopathy Other (specify in the clinic name field) Medical registration number * 4 to 24 letters, digits, / or - Registration year * Experience (years) * No minimum — freshers can apply. Enter 0 if you are just starting. Clinic name * No clinic yet? Enter a name like “Dr. Rajat Sharma’s Clinic”. Teleconsultation fee (₹) * What a patient pays for one video consultation. You set your own fee — the platform does not set or cap it.
Speciality *
Search and select every speciality you consult in. If yours is not listed, type it and add it.
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Cardiologist Dentist Dermatologist Diabetologist Dietitian/Nutritionist Emergency & Critical Care ENT ENT Specialist Family Physician Gastroenterologist General Medicine General Physician General Surgeon General Surgery Genetic Counselor Geriatrician Gynecologist/Obstetrician Homoeopath Infectious Disease Internal Medicine physician Laparoscopic Surgeon Neurologist Obstetrics & Gynecology Orthopedist Paediatrics Pain Management Palliative Care Physician Pediatrician Plastic and Cosmetic surgeon Proctologist Psychiatry Pulmonologist Sexologist Spine And Pain Specialist Spine Surgeon Urologist No match. Add “ ”
Documents
Your photograph *
A clear, recent head-and-shoulders photograph. Patients see this on your profile when they choose a doctor, so it should look like a clinician at work — not a group photo or an ID scan.
Choose file JPG or PNG · up to 10 MB
Medical registration certificate *
The registration certificate issued by your council, showing your name and registration number.
Choose file PDF, JPG or PNG · up to 10 MB
Address proof *
Aadhaar, passport, driving licence, voter ID or a utility bill in your name.
Choose file PDF, JPG or PNG · up to 10 MB
Other professional verification Optional
Anything else that supports your practice — clinic registration, fellowship, speciality board certificate.
Choose file PDF, JPG or PNG · up to 10 MB
8 Review and submit
Read this back carefully. You are attesting that it is accurate.
Use Edit on any section to correct it.
How your information is handled
Your answers and documents (registration certificate, address proof, photograph,
signature) are used only to verify and onboard you as a doctor on the ClinicWala
platform, under India’s Digital Personal Data Protection Act, 2023. Documents are
stored on ClinicWala’s server in a private area — they are not published, and they
are never sent as email attachments. If you are onboarded, they are kept for as
long as you are empanelled with ClinicWala; if your application is not approved,
or you withdraw it, they are deleted within 90 days. To access or correct your
application, withdraw your consent, or have your documents deleted, write to
info@clinicwala.com or call
788 000 3838. If you are not satisfied with how we handle such a
request, you may complain to the Data Protection Board of India. See also our
privacy policy .
I consent to ClinicWala collecting and processing the information and documents
in this application, including my address proof and specimen signature, to
verify my credentials and onboard me as a doctor on the ClinicWala platform. I
understand I can withdraw this consent at any time by writing to
info@clinicwala.com, and that if I withdraw before onboarding my application
closes and my documents are deleted.
I confirm that the information and documents I have submitted are accurate,
genuine and belong to me. I understand that ClinicWala verifies medical
registration and qualifications, and that a false declaration may lead to my
registration being refused or withdrawn.