SFRD Healthcare Professional Network - Onboarding & Partnership Form

Section A: Personal & Professional Identity

Welcome to the SFRD National Healthcare Professional Network. This section helps us verify your professional credentials and create your profile in our secure directory.

First Name *

Last Name *

Date of Birth *

Gender *

Primary Professional Email *

This will be your primary communication ID.

Mobile Number *

For communication from the SFRD Secretariat team. This will not be shared with patients.

State Medical Council Registration Number *

National Medical Register ID: *

LinkedIn Profile URL

Sharing this helps us understand your professional background better.

Social Media Handles (if any)

Add links to your primary professional social channels.

Practice Address Details

State *

City *

Full Address *

Pincode *

Section C: Rare Disease Experience & Expertise

Do you have hands-on experience in treating rare diseases? *

YesNo

Section E: Contributing to the Mission

Beyond clinical care, your expertise can strengthen our entire ecosystem. Let us know how else you might contribute.

Patient Identification & Diagnosis (e.g., Identify referrals, screening new patients, diagnostics)Education & Empowerment (e.g., Speaker for CMEs, Webinars, translating or vetting content, research in RDs)Patient Support (e.g., 'Ask the Expert' sessions for families, Counselling)Advocacy (e.g., Reviewing policy documents for medical accuracy)Mentorship & Teaching (Guiding junior doctors in the SFRD network)A Specific Rare Disease / Expert Patient Organization

Section F: Professional Consent & Agreement (Mandatory)

Please read the following statements carefully. This agreement formalizes your voluntary partnership with the Saba Foundation for Rare Diseases.

I understand that my partnership with SFRD is voluntary and I can choose to end my association at any time by providing written notice.I consent to SFRD securely storing my professional information provided in this form in its internal, verified database of healthcare professionals.I consent to SFRD sharing my Name, Specialization, and City of Practice with patients/caregivers who are seeking a specialist, only after they have been screened by the SFRD support team. I understand my direct contact details (phone/email) will not be shared without my explicit permission on a case-by-case basis.I agree to uphold the highest standards of medical ethics and maintain strict patient confidentiality for all cases and information shared with me through the SFRD network, in accordance with the guidelines of the National Medical Commission.I agree to share Photographs or videos taken of me on a site may be used by SFRD for promotional purposes.Monetary Waiver: I hereby waive all claims to monetary benefits for services rendered as a Volunteer on a 'Without Compensation Basis' for an indefinite period.This agreement may be cancelled by either party upon written notice. I understand that failure to comply with any of these conditions may result in my exit from SFRD Network.By checking this box, I confirm that all the information provided is accurate to the best of my knowledge and I agree to the terms of this partnership.

Full Name (as digital signature) *

Date

Digital Signature *

SFRD Healthcare Professional Network - Onboarding & Partnership Form

Section A: Personal & Professional Identity

Practice Address Details

Section B: Specialization & Employment

Please provide the following details, if any:

Specialization Mastery & Status

Workspace Location Details

Section C: Rare Disease Experience & Expertise

Section D: Your Engagement with SFRD

Section E: Contributing to the Mission

Section F: Professional Consent & Agreement (Mandatory)