Doctor Registration Form

    Please fill out Registration Form. Our Clinical Director will review your detail and will contact you to discuss further process.

    Are you still working with NHS? *
    YesNo

    Are you GP? *

    Are you still working with Consultant? *
    YesNo

    Do you have valid insurance & Indemnity cover to offer private practice at our clinic?

    What services / Speciality do you offer? *

    Service 1Service 2Service 3

    Please attach your updated CV detailing your qualification & Job Experience, Key Achievements & Skills *

    Professional Certifications


    1st Copy


    2nd Copy


    3rd Copy

    Signature