Doctor Application Form

Complete the registration form with your professional details and credentials.

Our team will review your qualifications and complete the verification process.

Once approved, you'll receive access to our platform and comprehensive onboarding support.

Complete this brief form to begin your journey with MedAssure. Our physician liaison team will guide you through the rest of the process.

5-minute application No commitment required Personal onboarding support

First Name*

Last Name*

Email Address*

Phone Number*

Primary Specialty*

Years of Experience*

Primary Hospital/Institution*

City*

Upload CV/Resume*

Choose File

Upload Medical License*

Choose File

Areas of Special Expertise

Typical Availability Per Week

Additional Information

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