Consultant Application

Apply to join the Nigeria care network. Your credentials will be reviewed before account activation.

Title (optional)Full NameEmailPhoneSpecialtyLicense NumberLicense Issuing State (Nigeria)CountryYears of ExperiencePractice AddressProfessional SummaryGovernment ID TypeGovernment ID NumberMedical Reference 1 NameMedical Reference 1 PhoneMedical Reference 1 EmailMedical Reference 2 NameMedical Reference 2 PhoneMedical Reference 2 EmailHospitals/Places Worked In The Last 5 YearsOther Professional QualificationsContinuing Education Programs (CEPs)Passport PhotoDate of BirthMedical SchoolGraduation YearLicense Expiry DateMedical Indemnity / Insurance ProviderInsurance Policy NumberInsurance Expiry Date

Review required documents before attesting: Consultant Code of Conduct v2026.02, Telemedicine Clinical And Safety Policy v2026.02, Patient Privacy And Confidentiality Rules v2026.02.

I attest that I have read and accept the Consultant Code of Conduct.I attest that I will follow telemedicine clinical and safety policies.I attest that I will comply with patient privacy and confidentiality rules.

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