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Pradhan Mantri Surakshit Matritva Abhiyan
Registration
Join
PMSMA !
Are you an Obstetrician/Radiologist/Physician ready to volunteer? Register yourself for Pradhan Mantri Surakshit Matritva Abhiyan.
In case of queries, please call PMSMA Helpdesk at
1800-180-1104
Volunteer Registration
This form is for registration of doctors from private sector/ voluntary sector/ for retired doctors.
Name:
Title
Mr.
Ms.
Gender:
Male
Female
Transgender
Working in:
Private Sector
Voluntary Organization
Retired
Qualification:
MBBS
Specialization:
Select Specialization
MD(Obstetrician/Gynecologist)
DGO
Radiologist
Others
None
Mobile No.:
Email Address:
MCI/State Medical Council Registration Number:
Upload Registration Doucment
(optional)
:
(PDF/JPG – 3mb Only)
Member of any Professional Body:
Select Organisation
FOGSI
IMA
Rotary
Lions Club
NGO
None
Others
Residential State:
Select State
Residential District:
Select District
Address :
Volunteering for:
State:
Select State
ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PUDUCHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
District:
Select District
I accept the
Terms and Conditions
I understand that, should I be accepted as a volunteer in PMSMA, I will abide by the rules of the programme. As a volunteer, I will respect the confidentiality of the information.
Volunteers under the PMSMA programme will offer their services to government health facilities without receiving any form of compensation.
I certify that the information submitted in the registration form are true and complete to the best of my knowledge.