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Patient Registration

Email Address *

Password *

Password must contain:

Minimum of 8 characters

At least 1 lowercase letter (a-z)

At least 1 uppercase letter (A-Z)

At least 1 number (0-9)

Confirm Password *

First Name *

Middle Initial

Last Name *

Mobile Number *

Address *

Birth Date *

Sex *

Civil Status *

Blood Type *

Emergency Contact *

Emergency Contact Number *

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Doctor Registration

Email Address *

Password *

Password must contain:

Minimum of 8 characters

At least 1 lowercase letter (a-z)

At least 1 uppercase letter (A-Z)

At least 1 number (0-9)

Confirm Password *

First Name *

Middle Initial

Last Name *

Mobile Number *

Address *

Birth Date *

Sex *

Civil Status *

Blood Type *

Emergency Contact *

Emergency Contact Number *

Professional Information

License No. *

Specializations *

Anesthesiology

Cardiology

Dermatology

Endocrinology

Gastroenterology

Infectious Diseases

Internal Medicine

Nephrology

Neurology

Obstetrics & Gynecology

Ophthalmology

Orthopedics

Otolaryngology - ENT

Pediatrics

Psychiatry

Pulmonology

Rheumatology

Surgery

Urology

Type a new specialization and click "Add" to include it in your selection.

Selected Specializations:

Medical Board Certification *

Specify Other Certification

Affiliations

Years of Experience

TIN *

PhilHealth Accreditation No. Required only if you process PhilHealth claims

DOH Accreditation If applicable

Professional Liability Insurance

Select Clinics *

Daraman Dental Clinic
Ozamis

Test Clinic
Test Clinic Location

Cebudoc Clinic
Cebudoc

Clinic X
Location X

XTerrain
Japan

Add New Clinic

New Clinic Details

Clinic Name *

Clinic Location *

Clinic Telephone Number * Format: XXX-XXXX

Clinic Phone Number * Format: 09XXXXXXXXX

Clinic Email Address *

Clinic Starting Time *

Clinic Closing Time *

Clinic Status *

Payment Information

Doctor registration requires a payment of ₱1,000.00 for continued access to all features.

Payment instructions will be sent to your email after registration.

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