SMS Clinic Empanelment

Clinic Empanelment Form

"Stronger healthcare through trusted partnerships."

General Info

Contact Details

Clinic Overview

Other Details

Clinic Name

Trade License

Add file

Upload

GST Certificate

Add file

Upload

Upload PAN Card

Add file

Upload

Trade License Number

GST Number

PAN Number

Clinical Establishment Act

Add file

Upload

Clinical Establishment Act Number

Clinic Ownership

Clinic Premises

Type of speciality

Address Line 1

Address Line 2

Area

City

State

Country

Pincode

POC - Point of Contact

Clinic Website Link

Clinic Profile

ADD MORE CREDENTIALS

Specialities

Is Pharmacy available (In-House)?

YES

Is Blood Bank available (In-House)?

YES

Is Ambulance available (In-House)?

YES

Are you Willing to Collaborate with sms24hrs ?

YES