Healthcare - Registration

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Facility Name * Please enter the name of your facility.

Facility Type * Please select the type of facility: Inpatient, Outpatient, or Both.

Facility Email * Please enter a valid email address for your facility.

Facility Password * Create a strong password for your account.

Facility Phone Number *

Enter a contact number for your facility.

Facility Country * Select the country where your facility is located.

Country Currency * The currency will be set automatically based on the selected country.

Facility Address * Start typing the address to your facility.

Facility Representative Name * Enter the name of the representative of the facility.

Facility Representative Role * Enter your role with this facility.

Facility Representative Phone Number * Enter a contact number for the representative.

XAF 10,000

XAF 27,000

XAF 50,000

XAF 1,000

Please review the plan details before proceeding.