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Do you know
that ...
Singapore was the first country in the region to be honoured by having a disease -- Tay's Syndrome -- named after its discoverer, Dr Tay Chong Hai, a consultant physician at the Singapore General Hospital.

Source: Website of the Ministry of Health, Singapore

doctor registration

Thank you for your interest in Ezyhealth Doctor's Net.
Kindly fill in the form below and click "Register" afterwards.
Items with an asterisk (*) are required fields

Personal Information

The surname and given name(s) can contain only valid characters : upper and lower case letters, numbers, underscore ( _ ) and dot ( . ). e.g. : Tan Kok Lim Andrew

Surname*

e.g. : Tan

Given Name(s)

e.g. : Kok_Lim

e.g. : Andrew

Gender*

Birthdate

Area of work*

Existing E-mail Address

Mobile Phone
-
(Country Code - Phone Number)

Pager

Account Information

Please choose your preferred User Name. This information will be asked when you log in to all the services provided by Ezyhealth Doctor's Net. The User Name will also be used for your email account with format of : username@ezyhealth.com

Preferred User Name *

The User Name can contain only valid characters
(Upper and lower case letters, numbers, underscore ( _ ) and dot (.) ).

Specialty Information

Specialty Area *

Place of Graduation*

Year of Graduation*

( in four digit format, eg. 1987 )

MCR Number*

Higher Academic Qualification

Address

Name of Employer/Clinic*

Clinic's Operating Hour

Office Address *

City*

State

Postal Code*

Country*

Office Phone*
- -
(Country Code - Area Code - Phone Number)

Office Fax
- -
(Country Code - Area Code - Fax Number)

Item with double asterisks (**) are required if you fill in the home address

Home Address **
(Home Address is optional)

City**

State

Postal Code**

Country**

Home Phone Number**
- -
(Country Code - Area Code - Phone Number)

Home Fax Number
- -
(Country Code - Area Code - Fax Number)

Contact Information

Our customer service department will contact you within three working days of receiving your registration. Please ensure that your contact number is valid.

We understand that a lot of our valued customers are people with tight schedules. In order to enjoy our service better, please specify the best time and the contact phone number for us to contact you.

The best time to contact you		at

Other Information

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