Afghan Connect Telehealth Platform

Medical Professional Registration, Telehealth and Training Program Application

Personal Information

Gender *

Professional Information

Are you currently involved in telehealth services? *
Do you have prior experience with virtual or online medical training? *

Telehealth & Training Program Participation

Availability for Training Sessions *
Do you have reliable internet for live sessions? *
Languages Spoken *
Select at least one language.
Are you willing to participate in both training and telehealth consultations? *

Required Documents

Accepted formats: PDF, JPG, PNG, DOC and DOCX.
Accepted formats: PDF, JPG and PNG.
Keep the total size of all documents below 10 MB.

Additional Information

Agreement and Acknowledgement

By submitting this form, the applicant agrees that the submitted information and documents may be processed for application verification, training and telehealth program administration.

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