Healthcare Provider Registration

Basic Information

Provider Type *

Please select a provider type.

Name *

Email *

Phone Number *

Provider Details

Logo *

Recommended: 300x300px, PNG or JPG

Featured Image *

Recommended: 1200x600px, PNG or JPG

Accepted Insurances

Services Offered

Average Waiting Time (minutes)

Working Hours

Location Information

Search Address *

Start typing your address and select from suggestions

Location Map

Drag the marker to adjust your precise location

Street Address *

Please select a valid address from the map.

City

State/Province *

Country *

Postal/ZIP Code

Address Line 2 (Optional)

Payment Information

Select a Subscription Plan

Basic Monthly

US$ 25.00 per month

Perfect for getting started

Basic listing
Up to 5 services
Standard support

Select this plan

Basic Quarterly

US$ 70.00 every 3 months

Save 35% compared to monthly

Basic listing
Up to 5 services
Standard support

Select this plan

Premium Half Yearly

US$ 130.00 every 6 months

Premium features at great value

Featured listing
Unlimited services
Priority support
Analytics dashboard

Select this plan

Premium Yearly

US$ 250.00 per year

Best value - save 40%

Featured listing
Unlimited services
Priority support
Analytics dashboard
Custom domain

Select this plan

Payment Details

Card Number *

Cardholder Name *

Expiration Month *

Expiration Year *

CVV *

I agree to the Terms of Service and Privacy Policy *

You must agree to the terms and conditions before proceeding.

Secure Payment

Your payment information is encrypted and secure. We use Authorize.Net for payment processing and never store your full card details.

Day	Opening Time	Closing Time	Closed
Monday			Closed
Tuesday			Closed
Wednesday			Closed
Thursday			Closed
Friday			Closed
Saturday			Closed
Sunday			Closed

Basic Information

Provider Details

Location Information

Payment Information

Select a Subscription Plan

Basic Monthly

Basic Quarterly

Premium Half Yearly

Premium Yearly

Selected Plan: Basic Monthly

US$ 25.00

Payment Details

Secure Payment

Set Working Hours