Join EMR Pro

Fill the form below.

EMR Pro Prescriber Registration Form

Clinic Information

Clinic / Organisation Name

Clinic Address

Street Address

City

Province

Postal Code

Country

Subscriber(s) Information

First

Last

Qualification

Phone

4 Digit Pin

Reg Number Type

Reg Number

Address of Recipient

Street Address

City

State / Province

Post Code

Country

Documents

Passport / Photo ID Scanned

File Upload

Signature Image (for PDF)

File Upload

Proof of Address (Utility Bill or Council Tax)

File Upload

Any other information

I accept

Sign Here

Where you hear about us?

Other

I consent to have eHealth Solutions Ltd. my submitted information so they can process my registration and, if needed I can request to delete my data on my request under the GDPR guidelines..

I have read and agree to the Terms and Conditions and Privacy Policy