Partner Registration - Chandauli Health Card

1

Organization Details

Choose your partner category and enter your centre information.

Partner category *

HospitalLab / Diagnostic CentreHospital & Ambulance

Hospital / Lab / Diagnostic Centre Name * Address * City * State * PIN Code * Year of Establishment Registration / License No. *

Business ConstitutionProprietorshipPartnershipPvt. Ltd.Other

GST Number (if applicable) PAN Number Lab / Diagnostic License No.

Accreditation StatusApplied / In ProcessNot ApplicableOther AccreditationNot Accredited

2

Who should we contact about this application?

Name * Designation Mobile Number * WhatsApp Number Alternate Phone Email ID *

3

Select all services available at your centre.

4

Share member discounts, turnaround times and support needs.

5

Proposed commercial terms for the partnership.

MedFlow Service Charge (%) Settlement Cycle If Other, specify

Payment ModeUPIBank Transfer

6

Tick the documents you are providing. Upload self-attested copies in PDF, JPG or PNG format (up to 5 MB each).

Select supporting documentsMaximum 10 files. Documents are stored privately outside the website folder.