Doctors & Field Clinicians | Registration

First Name

Last Name

Email address

Gender

Female

Male

Prefer not to say

Your role/position

Your medical specialty or area(s) of expertise

Name of your hospital/clinic/organisation

Postal address of your hospital or clinic

Phone number

The type of hospital/clinic (i.e. Teaching, Specialist, Local, Community, etc.)

Please provide details of your medical accreditation (e.g. equivalent to a GMC number)

Working language

What other languages do you speak?

Please upload proof of your medical accrediation or documentation that shows you are associated with childrens healthcare.

Upload File

Upload supported file (Max 15MB)

Which mobile device(s) are you currently using? Required

Android tablet

iOS tablet (iPad)

Android smartphone

iOS smartphone (iPhone)

Which remote specialist groups would be most useful to you?

Will you commit to updating the remote specialist on the outcome of each case you have referred?

Which specialist services are available at your site?

Does your site have short-term hospitalisation service? If yes, please include details.

How many doctors, nurses and other trained medical staff does your facility employ?

How many patients do you/your team normally see in a day?

What arrangements are made for the treatment of patients who are unable to pay?

How many beds does your facility comprise?

What type of diagnostic equipment is available at your facility?

Do you have a maternity unit?

What is the availability of up to date drugs?

Where did you hear about us? Your answer will help us in our efforts to map out our global network of specialists.

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