Section A: Clinic Details

Basic Information



Address Details

Contact Details

Bank Account Details

Section B: Workforce. Number of Staff

Total clinic staff

Specialist medical practitioner

Non-specialist medical practitioner


Assistant medical officer

Practice nurse (diploma / degree in nursing)

Community / home care nurse (certificate in nursing)

Clinic assistant

Receptionist / clerk

Section C: Services Provided In The Clinic

patients / day

Section D: Electronic Health Records

Does the clinic use a computer system?

Acceptance of Terms of Service, Privacy Policy

Section E: Document Upload

Certificate of registration to operate private medical clinic (Borang B or Borang F, with Lampiran if applicable), scanned in colour

MMC full registration certificate of person-in-charge

Current annual practising certificate (APC) of person-in-charge (APC 2023)

Proof of Bank Account (Bank statement or account verification letter by bank, which contains clinic/company name as per in Borang B/F)