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Physician Registration
First name
Last name
Medical license
For physician who does not have medical license, please fill in with "-".
Email
The email that was registered on the doctor information system of your hospital or you can use the company email in case of domain user account.
Account type
Domain User
Local User
Username
Your username must start with letter.
Your username must contain at least 5 characters of letter, digit, dash, dot and underscore only.
Password
