Get Application Form For Provisional Registration Of Clinical Establishments

This guide provides a comprehensive overview of how to effectively complete the Application Form for Provisional Registration of Clinical Establishments online. Each section of the form is explained in detail to support users at every stage of the process.

Follow the steps to complete the application form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, enter the name of the establishment. Fill in the full address, including village/town/city, district, block, state, telephone number with STD code, pin code, email ID, mobile number, and website if applicable.
3. Provide the name of the owner of the establishment along with their address details including village/town/city, district, telephone number with STD code, block, state, and mobile number.
4. Next, input the name of the person in charge, their pin code, email ID, qualifications, registration number, the name of the council they are registered with, and their contact information.
5. Indicate the ownership type by selecting from options such as government/public sector or private sector. Choose the applicable sub-categories under each main ownership option accordingly.
6. Tick the systems of medicine offered by your establishment based on your services, including options like allopathy, ayurveda, or homeopathy.
7. Select the type of clinical services being provided, categorizing them as general, single specialty, multi specialty, or super specialty.
8. In the next section, determine the type of clinical establishment by checking all that apply, such as inpatient, outpatient, or laboratory.
9. Conclude the form by reviewing the declaration statement. Ensure that you have understood and agree to the terms outlined regarding the accuracy of information and obligations.
10. Finally, save the completed form, and if necessary, download or print a copy for your records. You may also share the form with the relevant authorities electronically.

Take the first step towards provisional registration by filling out your application form online today.