Gabify Expert Onboarding Form
Join India’s fastest-growing AI-powered platform supporting early detection and care for speech & neurodevelopmental needs.
Customer Details:
Full Name (as per professional license):
*
First Name
Last Name
Gender:
*
Male
Female
Non-binary
Prefer not to say
Date of Birth:
*
-
Month
-
Day
Year
Date
Phone Number (WhatsApp preferred):
*
E-mail
*
example@example.com
Current City & State:
Languages Spoken:
Country
Professional Details
Primary Profession:
*
Please Select
☐ Speech Therapist
☐ Occupational Therapist
☐ Pediatrician
☐ Neurologist
☐ Child Psychologist
☐ ABA Therapist
☐ Clinical Psychologist
☐ Special Educator
☐ Other:________________________
If selected "other"
Years of Experience:
*
Highest Qualification:
Medical Registration Number / License:
*
Specializations (e.g., Autism, ADHD, Speech Delay, etc.):
Affiliated Hospitals/Clinics (if any):
Are you currently practicing independently or with an organization?
Independent Practice
Organization
Availability & Services
Consultation Mode:
Online (Video/Audio)
In-Clinic
Home Visits
All of the above
Available Days & Time Slots:(e.g., Mon–Fri, 10 AM – 1 PM & 4 PM – 7 PM)
Languages You Can Consult In:
English
Hindi
Regional (Please specify):
Please specify:
Do you offer Diagnosis Services?
Yes
No
Do you offer Therapy Sessions?
Yes
No
Typical Session Duration:
30 Mins
45 Mins
60 Mins
Other (Please Specify)
Please specify:
Consultation Fee (Online)
Consultation Fee (Offline)
Consultation Fee (Home)
Document Uploads
(Please upload clear copies of the following)
Government ID (Aadhaar/PAN/Passport)
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Degree Certificates
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Medical Registration Certificate / RCI Certificate
*
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Passport-size Photograph
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Clinic/Hospital Proof (if applicable)
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Profile Information for Marketplace Listing
Brief Bio (max 500 characters):
Tell parents about your experience, approach, and values.
Display Picture (JPG/PNG preferred):
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Social Media or Website Links (Optional):
Consent & Declaration
Kindly tick all the boxes:
*
I hereby declare that the above information is true to the best of my knowledge and belief.
I give consent to Gabify to verify my credentials and display my profile on its marketplace.
I agree to the Terms & Conditions and Privacy Policy of Gabify on https://www.gabify.life
I authorize Gabify to list my professional profile on its app and web platform to help me connect with potential clients and cases.
I permit Gabify to contact me via phone, WhatsApp, or email to:Share important updates,Provide onboarding assistance,Introduce new features or services,And inform me about collaboration opportunities.
Date
*
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Month
-
Day
Year
Date
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