Medical, Health & Family Welfare Department, Government of Rajasthan

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

श्री भजनलाल शर्मा

माननीय मुख्यमंत्री

श्री गजेन्द्र सिंह

माननीय चि. एवं स्वा. मंत्री

ESTABLISHMENT Registration Form Check Form Status

Mental Health Professionals
Registration Form

Details of Professional

Salutation*

Full Name*

DOB*

Select Gender*

Email*

Mobile*

Identification Proof *

(i.e. Driving Licence, Voter Card, Passport, or Aadhar Card can serve as Photo ID)
Size should be <5MB. (jpg, jpeg, png, pdf only)

Choose file...

Profile Photo*

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

Choose file.

Upload Address Proof*

(Upload Proof of Address for Work or Residence in Rajasthan)
Size should be <5MB. (jpg, jpeg, pdf only)

Choose file...

Work Address in Rajasthan/Location's of Practice*

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*

Discipline (Mental Health Nurse /Psychiatric Nurse)

Your Discipline*

System of Medicine*

Registered Under/ Act Name*

Professional Experience in Psychiatry (in.years)*

Registration No*

Upload Registration Proof (Act Under Registered i.e. RMC, RNC, RCI etc.). File Size should be <5MB. (jpg, jpeg, pdf only)*

Select File...

Education Qualification Details

Educational Specialization*

Degree Name*

Name of College/University*

Upload Degree Document ( File Size should be <5MB. (jpg, jpeg, pdf only)*