VHGlobal Virtual Clinic Registration
Thank you for your interest in VHGlobal Virtual Clinic cloud software. Please complete and submit the following form, and our Customer Service Representative will be in touch with you shortly. For any questions, please feel free to email us at support@vhglobal.org or Whatsapp us at 010-3854922.
Sign in to Google to save your progress. Learn more
Clinic/Healthcare Facility Name (this is the name that will appear in the system) *
Clinic/Healthcare Facility Full Address *
Person in charge Name *
Person in charge E-mail (This is the email that will be used to create the Admin account) *
Person in charge Phone Number *
How many doctors/medical practitioners are employed by your clinic/healthcare facility? *
Has your clinic/healthcare facility received the Geran Digital PMKS Madani before? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms