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Join Our Medical Network

Step 1: Select Your Role

Doctor

MBBS / MD / MS / BDS

Nurse

Registered Nurse / GNM / B.Sc

Support Staff

Ward Boy / Ayah / Caretaker

Ambulance Provider

Private / Hospital Ambulance

Step 2: Verify Phone Number

Phone Number *

This phone number is already registered.

Enter OTP

← Back to Roles

Step 3: Professional Profile Details

NMC Reg Name *

Qualification *

Reg. No *

Mobile Number *

Email ID *

This email is already registered.

Create Password * Password must be at least 8 characters long and include at least 1 letter (A-Z,a-z), 1 number (0-9), and 1 special character (!,@,#,$,%,^,&,*,_).

Confirm Password *

Full Name *

Gender *

Qualification *

Council/Authority *

Nursing Council Reg. No. *

Email ID *

This email is already registered.

Pincode *

City

State

Preferred Service Areas (Localities) *

Service Radius (in KM) *

Create Password * Password must be at least 8 characters long and include at least 1 letter, 1 number, and 1 special character.

Confirm Password *

Full Name *

Date of Birth *

Gender *

Marital Status

Father's / Husband's Name

Do You Own A Smartphone? *

Mobile Number *

Alternate Mobile

WhatsApp Number

Email Address *

This email is already registered.

Current Residential Address *

District *

State *

Pin Code *

Skills & Abilities *

Rate your ability for each skill (1 star = Basic, 5 stars = Expert)

Offline Form Filling (Handwriting) *

Online Form Filling (Computer / Tablet) *

I hereby declare that all the information provided above is true, complete, and correct to the best of my knowledge. I agree to follow all instructions given by the medical team and camp coordinator, and I consent to UBIQCURE using my information for programme-related communication and verification purposes.

I have read and agree to the above declaration. *

Create Password * Password must be at least 8 characters long and include at least 1 letter, 1 number, and 1 special character.

Confirm Password *

Ambulance Service Name *

Person In-Charge Name *

Designation *

Mobile Number *

WhatsApp Number

Email Address *

This email is already registered.

City / District *

Fill this short form and our team will activate your account. You agree to UBIQCURE contacting you for account activation and related communication.

I agree to be contacted for account activation. *

Create Password * Password must be at least 8 characters long and include at least 1 letter, 1 number, and 1 special character.

Confirm Password *

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