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Registration Form
Doctor / Admin Name*
Name of Hospital / Clinic*
Abbreviation (Name to print on QR code.)*
Mobile Number*
Phone Number
Email ID*
Address of Hospital / Clinic*
City*
State*
Pincode*
Admin Username*
Admin Password*
Confirm Admin Password*
Error: Please enter same Password in both the fields.
Admin Profile Password*
Confirm Admin Profile Password*
Error: Please enter same Profile Password in both the fields.
