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A Booming voice of the Indian HCP

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This platform is meant for Registered Medical Practitioners only.

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Full Name (as per PAN Card)*

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Healthcare Professional Agreement & SOW

Consent Form You are being invited to participate in a perception mapping survey conducted to understand doctors' opinions and perceptions regarding Himalaya Ghee Products. --- Participation Details · Voluntary Participation: Your participation in this survey is entirely voluntary. · Confidentiality: Your responses will be kept confidential and used solely for research purposes. No personally identifiable information will be shared. · Anonymity: Data will be analyzed and reported in aggregate, ensuring your anonymity. --- I have read and understood the purpose and details of this survey. I willingly provide my consent to participate and authorize the use of my responses for research and analysis purposes in compliance with confidentiality and ethical guidelines. Personal Details Dr. Name: Specialization: Contact Number: Date: Your valuable insights will contribute to improving product offerings and informing future healthcare collaborations. For any questions or concerns about this survey, please contact: Survey Coordinator Email: [email protected] Phone: 91471 08262 (Call/ WhatsApp)

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I have reviewed and agree to the terms and conditions outlined in the Health Professional Agreement and Statement of Work

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Pan Card

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HCP's Name Name in PAN Card

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Name mismatch with PAN. Update name in "HCP's Name" or upload correct PAN.

Success: HCP Name Verified

The entered name matches the name on your PAN Card.

Cancelled Cheque

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HCP's Name Name in Cheque

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Name mismatch with Cheque. Update name in 'Add HCP Details' or upload correct Cheque.

Success: HCP Name Verified

The entered name matches the name on your Cheque.

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Retailer Name * Retailer Code * City * State *

Full Name (as per PAN Card)

Phone Number

Speciality

NMC Registration Number

Address

Postal Code

City

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Doctor ID *

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