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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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*

Incharge Details

Salutation*

Full Name*

DOB*

Age*

Select Gender*

Email*

Mobile*

Registration Authority Name(Act Under Registered i.e. RMC, RNC, RCI etc)*

Registration No*

Registration Valid Till Date*

Degree Name*

Degree Number*

Degree Date*

Incharge Professional Experience

Post*

Place*

Joining Date*

Relieving Date

Total Experience: 0 Years 0 Months 0 Days

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

Upload Staff Details

(Accepted formats: CSV, XLS, XLSX only)

Download Format

(Download format and fill staff details & upload here)

Note:-
(1) Deposit the registration fees 20,000/-(Twenty thousand only)(Non Refundable) 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.

(2) Take the printout of duly filled form and attach self attested all necessary/ required documents along with staff's professional educational and experience documents and submit by post or by hand at the Office of Technical Advisor (SMHA) and Head of Department, Psychiatry Centre, Sethi Colony Jaipur, Rajasthan Pincode 302004.

(3) Attach a 100 rupee non judiciary stamp by the owner which states the declaration about information provided in the form is true and correct.

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

ESTABLISHMENT DETAILS

Previous License Details

ESTABLISHMENT Owner DETAILS

Present Address

Permanent Address

Incharge Details

Incharge Professional Experience

Proposed accommodations

Staff Pattern

MENTAL HEALTH ESTABLISHMENTRegistration Form

ESTABLISHMENT DETAILS

Previous License Details

ESTABLISHMENT Owner DETAILS

Present Address

Permanent Address

Incharge Details

Incharge Professional Experience

Proposed accommodations

Staff Pattern

MENTAL HEALTH ESTABLISHMENT
Registration Form