Clinic Manager Registration

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Clinic Registration

Complete the form below to set up your admin account

Verification Required
Your clinic will be reviewed within 24-48 hours after submission.

Clinic Information

Clinic Name *

First Name *

Last Name *

Contact Number *

Barangay *

Street/Address *

Clinic Location

Pin Your Clinic Location (Dasmariñas Only) *

Account Security

Admin Email *

Password *

Confirm Password *

Verification Documents

Clinic Verification Document *

Business permit, DTI, or SEC registration (PDF, JPG, PNG)

Face Authentication Image *

Clear front-facing photo for verification (JPG, PNG)

Valid Government ID *

Any valid government-issued ID (PDF, JPG, PNG)