What we do | Assistica MD | SaaS Efficiency for Small Claims

Company Name (or Individual’s)

Clinical area of Practice:

Select the type of services you would like to offer:

Location:

Country

City

Postal code

State

Address

Contact:

Cell Phone

Office Phone

Home Phone

Email Address

Home Page (Website)

Licensing & Credentials:

I am a credentialled provider of MDabroad

Medical License (Include translation to English)

License to prescribe medication (Include translation to English)

Certificate of Graduation from Medical School (Include translation to English)

Relevant Sub-specially boards (Include translation to English)

Name hospital(s) to which you have admitting privileges

Hospital Name

Medical Office Staff

Office Administrator Name

Office Telephone

Email Address

Other Key Staff

Cell Phone

Email Address

Medical Director of the Hospital

Name of the Medical Director

Cell Phone

Email Address

Add

Home Page

Medical Office Staff

Office Administrator Name

Office Telephone

Email Address

Other Key Staff

Cell Phone

Email Address

Medical Director of the Hospital

Name of the Medical Director

Cell Phone

Email Address

Delete Add

Home Page

Medical Office Staff

Office Administrator Name

Office Telephone

Email Address

Other Key Staff

Cell Phone

Email Address

Medical Director of the Hospital

Name of the Medical Director

Cell Phone

Email Address

Delete Add

Home Page

Medical Office Staff

Office Administrator Name

Office Telephone

Email Address

Other Key Staff

Cell Phone

Email Address

Medical Director of the Hospital

Name of the Medical Director

Cell Phone

Email Address

Delete Add

Home Page

Medical Office Staff

Office Administrator Name

Office Telephone

Email Address

Other Key Staff

Cell Phone

Email Address

Medical Director of the Hospital

Name of the Medical Director

Cell Phone

Email Address

Delete Add

Individual Medical Doctor

Location:

Contact:

Licensing & Credentials:

Name hospital(s) to which you have admitting privileges