Admission Form
Please fill in the form below.
Full Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Father's Name
First Name
Last Name
Mother's Name
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
State
Pin / Postal Code
Phone Number
*
Candidate Phone Number
-
Area Code
Phone Number
Parents Phone No
-
Area Code
Phone Number
E-mail
Make sure email is correct since all updates will be sent here
Course Name
*
BDS
BAMS
B. Pharma
D.Pharma
BSc. Nursing
DH
DM
GNM
ANM
MDS
Have you given NEET?
*
Yes
No
Current NEET Status
*
Qualified
Non-Qualified
NEET Score
Upload your NEET Scorecard
Screenshot / PDF of NEET Scorecard
MDS Departmental Preferences
Orthodontics
Oral Surgery
Periodontics
Pedodontics
Oral Pathology
Community Dentistry
Conservative & Endodontics
Oral Medicine
Prosthodontics
How did you hear about us?
*
Google Ads
Newspaper Ad
Facebook
Friends/Family
SMS
Radio Ads
Category
General
OBC
SC
ST
Enter the message as it's shown
*
Can we use these details to contact you via email, phone or text message to share information such as fees structure and admission process?
Yes
No
Submit Form
Should be Empty: