The Clinical Establishments (Registration and Regulation) Act, 2010
Registration Form for Clinical Establishment
All fields marked with * are mandatory
First Name
*
Middle Name
Last Name
*
Username
*
(Username Policy)
(Username you enter, lets you sign in to Clinical Establishment Application.)
Email ID
*
(All communication from CERR will be sent to this email address.)
Phone Number
Mobile Number
*
Designation
*
Select ID Proof
*
Select ID Proof
Aadhaar Card
Driving Licence
PAN Card
Passport
Voter ID
Enter ID Number
*
Enter ID Name
*
Enter Password
*
(Password Policy)
Confirm Password
*
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