Doctors Portal Registration

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1 Step 1

Titleyour full name

Initialsyour full name

First Nameyour full name

Surnameyour full name

Practice Telephone Numberyour full name

Cell Numberyour full name

Practice Numberyour full name

Specialityyour full name

Email Addressyour full name

Postal Addressmore details

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Physical Addressmore details

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By submitting this application, I confirm that:

I will treat confidentially any patient information viewed or accessed through the online viewing platforms provided by Dr Perumal and Partners Radiologist Inc.
I am fully aware of my obligations, inter alia in terms of confidentiality and safeguarding of personal information.
I will undertake to not use or disclose, directly or indirectly, confidential information for any purpose other than fulfilling my obligations in providing care to my patient.
I will not access in any form any patient data besides that which is relevant for me to fulfil my obligations in providing treatment to my patient or where the patient has legally requested me to do so.
I hereby indemnify Dr Perumal and Partners Radiologist Inc. and hold them harmless from any claim, damages or costs arising, directly or indirectly, from the breach of confidentiality.
PACS access will be granted and/or removed at the sole discretion of Perumal & Partners.

I confirm

Send me request pads