Phlebotomist Registration & Home Collection Network - Details Form
Join our home-collection network. Your mobile number is verified by your login.
Full Name *
Gender *
Male
Female
Mobile / WhatsApp Number (verified)
State *
Maharashtra
Goa
Gujarat
Karnataka
Madhya Pradesh
Telangana
District *
Sub-Area / Locality *
Total Years of Phlebotomy Experience *
Qualification (e.g. DMLT / BSc MLT)
Phlebotomy Experience Details
Do you have experience in Home Blood Collection? *
Yes
No
Home Visit Charges per Visit (₹) *
Do you have your own vehicle and a valid driving licence? *
Yes, both vehicle and valid licence
Vehicle available, but no valid licence
Valid licence, but no vehicle
Neither
Preferred Area for Home Collection *
Maximum Distance You Can Travel (km)
Availability for Home Visits *
Morning
Afternoon
Evening
Full Day
Current Working Status *
Full-time
Part-time
Freelance
Looking for work
Can you handle difficult / pediatric / elderly patients? *
Yes
No
Some experience
Aadhaar Number *
Stored securely - only a verification hash and last 4 digits are kept.
Service PIN Codes (comma-separated) *
Languages (comma-separated)
Any Additional Information
Submit Registration