Medical, Health & Family Welfare Department, Government of Rajasthan

Profile Photo*

Photo with dimensions of 3cm x 4cm, File Size should be <2MB. (Scanned copy of Profile photo (jpg, jpeg, png only))

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Identification Proof *

(i.e. Driving Licence, Voter Card, Passport, or Aadhar Card can serve as Photo ID)
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Previous License Details

Do you have a previous license?

Yes

Professional Experience

Post*

Place*

Joining Date*

Relieving Date

Total Experience: 0 Years 0 Months 0 Days

Present Address

Address Line 1*

Address Line 2*

City*

District*

State*

Pin Code*

Permanent Address

Same as Present Address

Address Line 1*

Address Line 2*

City*

District*

State*

Pin Code*

Proposed accommodations

Number of Rooms*

Number of Beds*

Facilities provided*

Out-patient Facility*

Emergency services*

In-patient Facility*

Occupational and recreational facilities*

ECT facilities (n X-Ray facilities)*

Psychological testing facilities*

Investigation and laboratory facilities*

Treatment facilities*

Staff Pattern

Number of Doctors*

Number of Nurses*

Number of Attendees*

Others

Note:- Deposit the registration fees 20,000/-(Twenty thousand only) in favour of The Chief Executive Officer, Rajasthan Mental Health Authority, Rajasthan in budget head 8342-00-103-42-14 - राज्य मानसिक स्वास्थ्य प्राधिकरण through e-GRAS & upload the successful transaction fees receipt.

I hereby declare that the information provided above is true and correct to the best of my knowledge. I understand that any false information may lead to the rejection of my application.

चिकित्सा, स्वास्थ्य एवं परिवार कल्याण विभाग Department of Medical, Health & Family Welfare

Megamenu

MENTAL HEALTH ESTABLISHMENT
Registration Form

Previous License Details

Professional Experience

Present Address

Permanent Address

Proposed accommodations

Staff Pattern

MENTAL HEALTH ESTABLISHMENTRegistration Form

Previous License Details

Professional Experience

Present Address

Permanent Address

Proposed accommodations

Staff Pattern

MENTAL HEALTH ESTABLISHMENT
Registration Form