DCA Eligibility Test

Are you a medical practitioner?

Yes No
Mention your specialized category *

Are you a full time active medical practitioner for a minimum period of one year immediately preceding the date of application? *

Yes No

How many years have you been actively practicing? *

2-5 yrs 5-20yrs 20 years or more

What category do you fall into? *

I’m a doctor in a group practice I have my own practice I have a family owned practice

Which describes your practice location? *

My practice belongs to a specific city My practice is a network with multiple offices in various cities

Do you have referring doctors who send their patients to your practice? *

Yes No

Do you refer your patients to other doctors you trust? *

Yes No

Are you a member / interested in becoming a member of a CME Organization? *

Yes No

Have you participated in an awards program before? *

Yes No

Let us know in a few words what interests you about participating for the Doctors’ Choice Awards? (E.g. I am excited about winning awards! ) *

Thank you for your time.
Please enter your contact details here and one of our representative will get back to you with more details on the award.
Name *
E-mail *
Mobile Number *
Website URL
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