COVID-19 SANGARSH SENANI

Total Count	Doctor	Nurse	Paramedics	Home Delivery	Social Distancing Comm.	Public Comm.	District Management	Tele Consult- Mental Health	Any Other
90015	1369	1178	3013	14893	13700	16941	13161	243	25500

Covid-19 Sangharsh Senani Form

Name^*

Father Name^*

Date of Birth ^*

Gender^*

Mobile Number^*

Aadhar Number

Flat/Door/Block No.^*

Premises/Building/Village^*

Road/Street/Post Office

State^*

District^*

Tehsil^*

Town / Village^*

Pin Code

Area Of Operations^*

Registration number^*

Registration Number^* Experience?^*

Experience?^*

Have a vehicle? Yes/ No^*

Vehicle Type?^* Vehicle Registration Number?^*

Please Specify if you are a Psychotherapist, Psychiatrist, Psychologist, MBBS Students etc.^*

Please Specify^*

Willingness/ Scope of Covid-19 Sangharsh Senani^* Anywhere near your area
Anywhere in your District