NOTE: Please complete all mandatory fields (*).
Hospital name: Please enter the name of the Hospital / Clinic you represent.
Email: Please enter a valid email address, your registration details will be sent to your registered email address.
Address: Please enter a valid address so that it is easier for patients to reach you.
Phone: Please select your country and enter your telephone number. It can either be a landline number or a mobile number.
Representative First name: Please enter your first name.
Representative Last name: Please enter your last name.
Designation: Please enter your designation.
Email: Please enter a valid email address where we can contact you.
Phone: Please select your country and enter your telephone number. It can either be a landline number or a mobile number.
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Your registration request has been successfully received. Please be informed that your registration approval is pending. We are working towards validating the information that you have provided. We will be in contact with you soon!
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Lyfboat Technologies Pvt. Ltd.
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Vasant Vihar - 110057
New Delhi, India
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