Create Account – DoctorOnTap

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Step 1 of 5

Personal Information

Your basic identity details so we can identify you.

Personal Information

Your basic identity details

Full Name *

Email Address *

Phone Number *

International number with country code (+…). Nigerian format 0XXXXXXXXXX is also accepted.

Gender *

Date of Birth *

Step 2 of 5

Location

Where you're based. Optional — you can add this later.

Location

Where you're based (optional)

Street Address *

State *

City *

Step 3 of 5

Medical Details

Help doctors serve you better. All fields required.

Medical Details

Help doctors serve you better

Blood Group *

Genotype *

Height (cm) *

Weight (kg) *

Allergies *

Chronic Conditions *

Current Medications *

Surgical History *

Family Medical History *

Step 4 of 5

Emergency Contact

Someone we can reach in an emergency. Required.

Emergency Contact

Someone we can reach in an emergency

Contact Name *

Phone *

Relationship *

Step 5 of 5

Account Security

Create a strong password to protect your account.

Account Security

Create a strong password to protect your account

Password *

Use at least 8 characters with uppercase, numbers & symbols.

Confirm Password *

How did you hear about us? *

I have read and agree to the . *

256-bit encrypted • Your data stays private

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