Apply to Join the EllisMD Provider Network

Complete the form below. All credentials are verified by EllisMD administrators.

Personal Information

Full legal name *

Date of birth

Email *

Mobile number

Address

Country

Parish

Government-issued ID upload *Choose file

Medical Council of Jamaica registration no. *

Registration expiration / renewal date *

Primary specialty *

Additional specialties

Medical degree

Medical school

Graduation year

Years in practice

Postgraduate qualifications

Board certifications

Current employer / practice (optional)

Upload clear copies of the following. Documents are reviewed and verified by EllisMD.

Medical degree *Choose file

Medical Council registration *Choose file

Specialty / postgraduate certificationChoose file

Malpractice / professional indemnity insuranceChoose file

CV / resume *Choose file