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Doctor Registration
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> Registration
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Select Membership
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Practice Profile
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Professional Profile
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Personal Profile
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Preferences
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Complete
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* indicates a mandatory field.
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My Account:
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Please enter your details in the space provided. Items that are starred are required for
registration.
The telephone number and e-mail address you enter here will be kept
private from the public.
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Suffix |
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Title |
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Gender |
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* First Name |
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Middle Name |
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* Last Name |
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* Main Specialty |
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Sub Specialty |
Subspeciality:
Please let us know if your subspeciality is missing.
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* Contact e-mail |
(Like:- ex@gmail.com) Not displayed to the public.
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* Contact Phone Number |
(xxx-xxx-xxxx) Not displayed to the public.
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Primary Office:
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List your primary office address here to be displayed on yourprofile. you wll have
a chance
to add additional offices under "practice profile".
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Practice Setting |
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Name of Practice |
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* Primary Office Address |
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* State |
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* City |
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* Zip |
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* Office Telephone |
(xxx-xxx-xxxx)
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Office Fax |
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Work e-mail |
E-mail:
If you enter an e-mail in this field it will be dispalyed to the public.
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Website |
Enter your web site.
like:- www.docmatcher.com
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Administrator:
If you would like your adminstrator to manage your account please provide the contact information. This is especially useful when accepting on-line appointments and for returning messages.
Administrator will manage on-line appointments
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* User Id |
User id:
Your user ID will be your own personal identification as a DocMatcher.com member and will not be diapalyed.
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* Password |
Password:
To make your password strong,please use 8 characters with at least one unmber and at least one special character(i.e. %,@).
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Your photograph |
Upload your photo to be display on your profile. Adding this has been shown to greatly enchance your hit rate.*Give doctors the best photos size (i.e.235x175 px).
Upload only .jpg, .jpeg, .gif, .png files.
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Verification:
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This section is used to verify the information provided to ensure your security
and
the safety of our other members.
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Status of License |
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License Number |
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Date of Issue |
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Expiration Date |
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Photo ID |
Photo ID is required for verification to help ensure your safety from fraud and other forms of misrepresentation and for the safty of patients. This information will never be shared with the public or any third parties.Any official state or government issued identification is accepted.Upload only .doc, .docx, .pdf, .jpg, .jpeg, .gif, .png files
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I have read and agree to the Terms of use and Privacy Policy.
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Would you like to subscribe to our e-mail list for newsletters,updates and announcements?
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Would you like to participate in third party offers?
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