Registration Form for Qualified Doctors

For Nigerian Doctors Only

Enter your MDCN license number

Select your area of specialty

Click to upload your portrait photo or drag and drop

PDF, PNG or JPG (max. 50mb)

First name

Last name

Email address

Phone number

Current Employment Status

Current Job Role

Name of Current Place of Work

Years with Current Employer

Medical School Attended

Year Graduated

Click to upload your certificate here or drag and drop

PDF, PNG or JPG (max. 50mb)

National Identity Number (NIN)

Referral Number (Optional)

State of residence

City of residence

Current residential address

Click to upload proof of residential address i.e NEPA Bill or drag and drop

PDF, PNG or JPG (max. 50mb)

I have read my role as a Doctor and agree with our Confidentiality and Condition of Usage Agreement.

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Coverage

36 States of the Federation Including the FCT, Abuja.

Address

No. 9 Akilo Road , Off Oba-Akran Avenue, Ikeja, Lagos State.

Contact

support@solace.com.ng

(+234) 802 7564 943

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