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PHYSIOTHERAPIST REGISTRATION DETAILS
PHYSIOTHERAPIST REGISTRATION DETAILS
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* Indicates required question
REFERRER ID
*
Fill NA if referrer ID not applicable
Your answer
REFERRER NAME
*
Fill NA if not applicable
Your answer
PHYSIOTHERAPIST NAME
*
Applicant Name
Your answer
GENDER
*
MALE
FEMALE
Required
EMAIL ID
*
Your answer
MOBILE NUMBER
*
Your answer
ADDRESS LINE 1
*
Your answer
ADDRESS LINE 2
Your answer
CITY
*
Your answer
STATE
*
Your answer
PINCODE
*
Your answer
COUNTRY
*
Your answer
LOCATION PREFERENCE OF WORK AREA
*
CHANDIGARH
PANCHKULA
ZIRAKPUR
OTHER
Required
ACADEMICS
*
BPT
MPT
Required
COLLEGE NAME - BPT
*
Your answer
COLLEGE NAME - MPT
*
Your answer
TOTAL CLINICAL EXPERIENCE
*
Your answer
IAP / HSCP REGISTRATION NUMBER
*
Your answer
BANK NAME
*
Your answer
BANK ACCOUNT NUMBER
*
Your answer
BANK IFSC CODE
*
Your answer
DATE
*
MM
/
DD
/
YYYY
ANY ADDITIONAL INFORMATION
Your answer
IDENTITY PROOF SUBMISSION
*
Share below mentioned identity proofs on email ID musclemotions2@gmail.com. Tick mark the proofs shared on email.
AADHAR CARD
PAN CARD
RENT AGREEMENT
PASSPORT SIZE PHOTOGRAPH
ACADEMIC CERTIFICATES (BPT or MPT DEGREE)
INTERNSHIP CERTIFICATE
CLINICAL EXPERIENCE CERTIFICATE
Required
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