<%@ Page Language="C#" AutoEventWireup="true" CodeFile="Register_Hospital.aspx.cs" Inherits="Register_Hospital" %> CITIZEN FORCE FOUNDATION FOR CITIZENS

Registrations will be commenced soon........

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Hospital Registration

Hospital Registration
Use dedicated Mobile for Hosiptal Registration(do not use your Personal Mobile as it will prevent your registration in your personal category)
 
Your Hospital Name & Address, Services, Specialities available, Name of the On-duty Doctor, Contact Number and Availability Times etc.,
will be displayed in "Services->Hospitals->Hospitals In My Area" by default.
In case, you do not wish to display the same BUT requires only personnel protection under Citizen Category, please UNCHECK the box here.
YOU CAN EDIT FROM TIME TO TIME THE INFORMATION PROVIDED HERE IN CERTAIN FIELDS AT ANY TIME THROUGH "LOGIN"
Pincode*
 :
State
 :
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District
 :
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Mandal / Taluk*
:
Post Office Name*
 :
Name of the Hospital* :
City / Town / Village :
Land Mark To Reach You Easily :
Locality / Area :
Street Name :
Ward / Division Number :
House Number :
Buliding Name :
Hospital's Emergency Contact Number : Land line:  -   Mobile: +91-
Contact Doctor / Person Name :      You can edit from Shift to Shift
Services Available :
In Patient Facility Available : YES NO
Ambulance Phone Number :
Email address :
Confirm Email address : <%----%>
Availability :
Days Timings(Eg: 24 Hours, 9AM-12NOON, 4PM-9PM ETC...)
*Dedicated Mobile number (This will be your Login ID and to receive/retrieve forgot password) : +91-(Password will be sent to this mobile)
*Conform Mobile number : +91-
Upload Photo :
Date & Time
 :
Security Code* :
Enter Security Code :
Form Filled By* :
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