Full Name (as in IC)* :
IC No* :   eg 811112013344
APC No* :   
Password* :   (six characters or more)
Re-Type Password* :   
Phone No* : -
E-mail :   
Please remember your Application ID and Password
One Application ID is valid for one (1) application only.

If you have more than one clinic to be registered, please use a different Application ID by signing up separately for each clinic
Once application is submitted, it can not be edited. If you wish to edit any information, kindly go to 'Direct Entry' and click on the information which needs editing, BEFORE SUBMITTING THE APPLICATION.