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Register as Practitioner
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Healthcare Facility Registration
Registration Type
Type of Registration:
Temporary
Permanent
Practitioner Type:
National
Foreign
Personal Details
Surname:
First Name:
Middle Name:
Nationality:
Select Type of ID
-- Select ID Type --
National ID card (e.g., NIN, National Identity Card)
Passport
Refugee ID Card
ID No:
Date of Birth:
Place:
Email:
Phone:
Academic Qualification
Academic Qualification/Degree:
University/Institution Name:
College/Faculty:
Year of Completion:
Country of Study:
Practitioner Category:
Medical Doctor
Pharmacist
Dentist
Foreign Practitioner Details
Name of Your Home Regulatory Council:
Reg. No:
Name of the Practice Institution:
Year of Completion:
Name of the Supervisor:
Supervisor Email:
Supervisor Phone:
Uploads
1. Photo
2. Qualification Certificate
3. Qualification Transcript
4. National ID/Passport
5. Registration from the Regulatory Council (if any)
6. Verification of Credentials (if studied abroad)
7. Internship Completion Letter
8. Payment Slip
9. App Form
Submit Practitioner Registration
Facility Details
Facility for:
New registration
Renewal
Upgrading to
License No (if for renewal):
Registration type:
Permanent registration
Preliminary registration
Facility Name:
Facility Type:
Physical Address:
State:
Select State
Central Equatoria
Eastern Equatoria
Jonglei
Lakes
Northern Bahr el Ghazal
Unity
Upper Nile
Warrap
Western Bahr el Ghazal
Western Equatoria
County:
City:
Street:
Email:
Contact Phone:
Year of Establishment:
Practitioner Information
Registration Number/ID*:
Surname:
First Name:
Other Name:
Practitioner Category:
Medical Doctor
Dentist
Pharmacist
Specialist
Specialty:
Reg. No:
License No:
Email:
Phone:
Uploads
1. Photo
2. National ID/Passport
3. Registration Certificate
4. Practice License
5. (Additional Upload)
Submit Facility Registration
Personal Details
Registration Number/ID*:
Citizenship*:
National
Foreign
Registration type:
Permanent registration
Preliminary registration
Nationality*:
Type of ID*:
ID No*:
Unique ID:
Qualification Details
Postgraduate Qualification*:
Year of Graduation*:
Specialty*:
Sub-Specialty:
Uploads
1. Photo
2. Postgraduate Qualification Certificate
3. Postgraduate Qualification Transcript
4. National ID/Passport
5. Registration from the Regulatory Council
6. Verification of Credentials
Submit Specialist Registration
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