OurCheckup - Doctor Empanelment Form

Doctor Empanelment Form

Personal Information

Full Name * Please ensure that the full name matches the name on your NRIC/Passport.

Email Address * We'll never share your email with anyone else.

Phone Number * We'll never share your phone number with anyone else.

Nationality *

NRIC * Example: 941003015645

NRIC Front Image * Please upload a JPEG or PNG image file that is less than 1MB.

NRIC Back Image * Please upload a JPEG or PNG image file that is less than 1MB.

Passport Image * Please upload a JPEG or PNG image file that is less than 1MB.

Professional Information

Annual Practicing Certificate Number *

Malaysian Medical Council Number *

Physician *

Hospital/Clinic Information

Name *

License Number

Phone No

Fax No

Hospital/Clinic Address

Address One *

Address Two *

State *

Postcode *

Country *

Attachments

Please upload the following documents in PDF format.

Current Annual Practicing Certificate * Please upload a PDF file that is less than 1MB.

Current Professional Indemnity Insurance

Curriculum Vitae

Academic & Medical Qualifications

MyPocketDoc Preferred: Enhance Your Practice, Empower Your Patients

MyPocketDoc Preferred is an exclusive telemedicine platform designed for doctors like you, who have built strong relationships with your existing patient base. It empowers you to manage consultations with your own patients remotely, fostering continuity of care and a highly personalized experience.

What makes MyPocketDoc Preferred unique?

While the standard MyPocketDoc platform connects you with a broader patient pool, MyPocketDoc Preferred allows you to:

Focus on Your Established Base
Maintain strong relationships and continuity of care by managing consultations with your existing patient base.
Set Your Own Rates
Take control of your finances by setting your own teleconsultation fees.
Seamless Virtual Care
Deliver consultations and follow-ups remotely, offering greater control over your schedule and practice location.
Personalised Experience
Provide the comfort and familiarity of consultations with their trusted doctor, directly benefiting your patients.

Who is MyPocketDoc Preferred for?

MyPocketDoc Preferred is designed for doctors who want to leverage the convenience of telemedicine while maintaining a professional setting. This programme is designed for doctors who own or practice at a physical clinic with existing patient base.

Ready to join?

You may click below to activate your own MyPocketDoc preferred in the empanelment form. You may also apply in the apps whenever you are ready to start your own virtual clinic.

Apply for MyPocketDoc Preferred Program

Teleconsultation Packages

Name

Credit Cost

Doctor Claim Amount (RM)

Revised Credit Cost

Revised Doctor Claim Amount (RM)

Name

Credit Cost

Doctor Claim Amount (RM)

Revised Credit Cost

Revised Doctor Claim Amount (RM)