Practitioner Profile Form
Process for Registration : The registration is a two step process. Please fill in this form for Login ID and Password that you will receive via E-mail and SMS. Please find the login link published on and login with the Login ID and Password and apply for Central Registration.
For any issue or clarifications please contact CCIM Helpdesk Email-Id: or Mobile Numbers: 9654401726, 9654401763
Practitioner Details
(Please write your name as per your Degree Certificate)
*Gender Male Female Transgender
*Date of Birth
*Mother's Name
*System of Medicine
Note : You can login from the Homepage of the CCIM Website after receipt of Login id and Password sent to your Mobile Number
and Email Id.
*Email Id
*Please re-enter Email Id
*Mobile Number
*Please re-enter Mobile Number

I, solemnly confirm that if any information provided by me is found false, I shall be held responsible in the matter. I shall have no objection if any action is taken by the CCIM against me.

    I Agree
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