THOSE DOCTORS WHOSE NAMES ARE NOT INCLUDED IN CENTRAL REGISTRY NOTIFIED BY CCIM MAY FILL THE DATA SHEET ATTACHED HERE.(THOSE WHO ARE ALREADY REGISTERED WITH CENTRAL REGISTRY BY CCIM ARE NOT REQUIRED TO FILL THE DATA SINCE IT CAUSE DUPLICATION)
PLEASE DO NOT LEAVE ANY OF THE COLUMNS BLANK.
Email *
PRACTITIONER'S NAME *
FATHER'S NAME *
DATE OF BIRTH(dd-mm-yyyy) *
MM
/
DD
/
YYYY
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