PHF AG

Basic Facility Information

Facility Name

Facility Code

Facility Type

Facility Category

Bed Capacity

Registration Number

Contact Details

Phone Number

Format: 0241234567 (10 digits)

Email Address

Street Address

Region

District

Postal Code

Additional Information

Medical Director Name

Website URL

Facility Description/Specialties

Regulatory Body Registrations

Please provide registration details for all applicable regulatory bodies. Mandatory bodies are required for facility registration.

Administrator Details

First Name

Middle Name

Last Name

Email Address

Phone Number

Format: 0241234567 (10 digits)

Username

Password

Minimum 8 characters

Confirm Password

Date of Birth

Gender

Residential Address

Required Documents

Hospital License Accepted formats: JPG, PNG, PDF (Max 5MB)

Accreditation Certificate Accepted formats: JPG, PNG, PDF (Max 5MB)

Insurance Certificate Accepted formats: JPG, PNG, PDF (Max 5MB)

Tax Registration Accepted formats: JPG, PNG, PDF (Max 5MB)

Additional Documents

Upload Other Documents You can upload multiple documents (PDF, JPG, PNG, DOC - Max 5MB each)

Terms & Conditions

I agree to the Terms and Conditions and confirm that all information provided is accurate.

Please fill in all required fields correctly.