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Health Mitra Registration Form

Fill in all details carefully. All information is verified before ID generation.

Health Mitra › Register

⚙️ After you submit, our system will automatically:

Step 3 Validate your Aadhaar Number format

Step 3 Verify your Qualification details

Step 4 Verify your Hospital ID Number

Step 4 Check for duplicate records

Step 5 Send for Admin Approval

📝 Enter Your Details

1. Full Name * (As per Aadhaar)

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Enter name exactly as it appears on your Aadhaar card

2. Age *

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Must be between 18 and 80 years

3. Sex *

5. Qualification *

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Highest Qualification Document * (PDF or Image, max 5MB)

4. Aadhaar Number *

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12-digit number from your Aadhaar card

6. Hospital ID Number *

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E.g. HOSP-12456 or your employee/patient ID

Mobile Number (for notifications)

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You will receive OTP/SMS notifications on this number

Email Address (optional)

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Address (optional)

I hereby declare that all the information provided above is true and correct to the best of my knowledge. I understand that providing false information may result in rejection or cancellation of my membership. I agree to abide by the rules and regulations of Thirupathi Hospitals Health Mitra Program.

💡 Note: All details are verified before ID generation. After submission, you can track your application status using the link provided. Admin approval is required before your Health Mitra ID is generated.