Doctors Questionnaires

"*" indicates required fields

Step 1 of 11

9%

Hospital Name

Hospital Location

How many years of practice experience do you have?*

<1 year

1-3 years

3-5 years

5-10 years

10+ years

Ownership status of the clinic/ hospital?*

Rented

Self owned

For how many years have practice experience to you have?*

0

1

2

3

How many cataract surgeries happened at the clinic/hospital in a year?*

<100

100-500

500+

Which of the following procedures can you perform?*

Cataract

Vitrectomy

Squint

Lasik

ICL

C3R

The total number of staff members in the clinic or hospital?

Doctor*

1

2

3

4

4<

Optometrist*

1

2

3

4

4<

Reception*

1

2

3

4

4<

Admin*

1

2

3

4

4<

Others*

1

2

3

4

4<

Which key TPA / Panels does the hospital clinic have?*

Please ticks the certifications that you have?*

QCI

NABH

BMW

Fire NOC

What are the key reasons why you want to partner with EyeMantra?(Tick all that apply)*

TPA/ Empanelments

Online marketing

Offline / Field marketing

Center management

Admin / Accounts

Business expansion

Confirm your details

Name*

Email*

Mobile Number*

Address*