Patient Registration Form
Join MAPSIV for better healthcare access
Basic Details
First Name *
Last Name *
Gender *
Select
Male
Female
Other
Date of Birth *
Blood Group
Select
A+
A-
B+
B-
O+
O-
AB+
AB-
Contact Details
Mobile Number *
Email *
Street Address
City
Country *
Identity Proof
ID Type
Select
Aadhaar
PAN
Driving License
Voter ID
Passport
Others
ID Number
Security Settings
OTP Receive Option (Select Preference) *
Email Only (Fast & Free)
SMS Only (Standard)
Both Email & SMS (High Security / 2FA)
* If 'Both' is selected, you need to verify both codes.
Create Password
Password *
Confirm Password *
Send OTP & Register
Enter 6-Digit OTP
Email OTP:
SMS OTP:
Verify & Complete Registration