New clinic request by clinic form

New clinic request form

This form can only be filled by a representative of the clinic
Clinic Name*
Contact email*
exemple@exemple.com
Contact phone/WhatsApp number*
Contact person & role*
Clinic information
Country*

SwitzerlandUAEOther
Years of activity*

Less than 1 year1 to 3 years3 to 5 years5 years+
Amount of locations*
Your Website*
Why should we add your clinic / Tell us about your clinic*
Our team will review your submission within 48 hours

We have our very own entry criteria, we will review your submission but can't guarantee that your clinic will get accepted.
Should be Empty:

New clinic request form