Partners' Form - CloudClinic

CLOUD CLINIC LIMITED PARTNERS' ONBOARDING FORM

Dear Partner, thank you for partnering with CloudClinic. 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/Diagnostic Centre Reference Hospital Others

What is your Facility Contact Number?

What is your Facility email?

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

Upload your logo

What is your social media handle?

CloudClinic connects different players in the health industry by providing a solution that works for doctors, patients, and health facilities alike.

CLOUD CLINIC LIMITED PARTNERS' ONBOARDING FORM

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