Paramparik Vaidya Registration Form

1. Full details of the Paramparik Vaidya

Name of the Paramparik Vaidya*

First Last

Email

Age*

Gender*

Male

Female

Others

Blood Group

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Number*

Aadhar Number

2. Details of the head of the family/mentor who imparted training to the paramparik vaidya

Full Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Number

3. Experience in practicing traditional health care

No of Years*

4. List your specialities in medicine

Mention here:*

Which plants do you mainly use for medicine?

5. Which of your specialties do you want to give priority for registration?

Select a speciality

Common Disease

Jaundice

Traditional Bone Setter

Arthritis

Poisonous Sting Bite

Traditional Birth Assistance

Other Expertise

6. Have you ever been 'registered' with a health organization before?*

Yes

No

If ‘yes’, then give information about that organization

Name of Organization

Address of Organization

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Head of Organization

Contact Number

7. If your ‘certification’ has been done by any organization, then provide its information

Name of Organization

Address of Organization

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Head of Organization

Year of Certification

Period of Validity of Certification

Contact Number

Upload Certificates

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 15 MB, Max. files: 3.

Traditional Medicine, Research, Training and Registration Initiative (In association with ‘Vigyan Bharati’)

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