Facility/Rehab Center Registration
Registration Form
Fill in the details of paitent and guardian
Facility/Establishment/Rehabilation Center Name:
Full Correspondence Address:
City:
State:
Pincode:
Landline number
(Primary)
:
Landline number
(Alternate)
:
Email ID
(Primary)
You will receive an activation email at this email id
:
Email ID
(Alternate)
:
Website:
Submit
NB: The administrator-level default login credentials (password and ID) will be generated and sent to the registered email address (above). When you initially log in, you have to change the default password.
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