CLOUD CLINIC LIMITED PARTNERS' ONBOARDING FORM
Dear Partner, As our launch dates is drawing near, we are gathering information to help us create your facility on our platform, as well as get your facility ID across to you so you can start your activation. Kindly fill this form to help us capture all the information we need.
Name of facility
*
Type of Facility
*
Pharmacy
Medical Laboratory
Reference Hospital
Others
What is your facility contact number?
*
What is your facility email?
example@example.com
What is your facility physical address?
*
Has your facility partnered with CloudClinic?
*
Yes
No
Do you have more than one branch?
*
Yes
No
Please input the name, email, address and contact number of your other branches below
What is your license number?
*
Upload your license
*
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Upload your logo
*
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