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  • First name is required
  • Last Name is Required
  • First name can only have letters. Maximum 60 characters.
  • Last name can only have letters.Maximum 60 characters.
  • Email is Required
  • Email address is not valid. Maximum 256 characters.
  • Password is Required
  • New password must contain at least one each lowercase letter, uppercase letter, number, special character, and must be 6 to 32 characters long
  • Confirm Password is Required
  • Password mismatched
  • Incorrect phone
  • Phone is required
  • Physician name is required
  • Date of Birth is Required
  • Gender is required
  • Street address is required
  • State is required
  • City is required
  • Invalid City
  • Zipcode is Required
  • Incorrect zip code
  • your state is wrong
Mandatory field
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