OMAS

General Information

Salutation *

First Name *

Last Name *

Mobile Number *

Email Address *

Date of Birth *

Age *

Gender *

Male

Female

Other

Residence Address

Street Address Line 1 *

Street Address Line 2 *

Country *

State *

City / District *

Pin / Zip Code *

Practice

Nature of Involvement in Bariatric Surgery *

Surgeon

Surgery Resident/Fellow

Specialist Physician

Nutritionist / Dietician

Nurse

Psychologist

Physical Therapist

Researcher

Physician resident / Fellow

Institute / Hospital *

Designation *

Door No. / Building Address *

Street Address *

Country *

State *

City / District *

Pin / Zip Code *

Work Experience

Bariatric Experience Since: *

Laparoscopic Surgery Experience Since: *

Robotic Surgery Experience Since: *

Obesity And Metabolic Surgery Society of India

OSSI

CICO Application

My Profile

Application

General Information

Residence Address

Practice

Work Experience