DCA Eligibility Test

Are you a medical practitioner?

YesNo
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?*

YesNo

How many years have you been actively practicing?*

2-5 yrs5-20yrs20 years or more

What category do you fall into?*

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

Which describes your practice location?*

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

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

YesNo

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

YesNo

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

YesNo

Have you participated in an awards program before?*

YesNo

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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