Please complete this form so we can set up your clinic or hospital on our EMR platform.
Keep ready: your logo and banner images, a staff list (CSV) and any prescription templates. You will share them as a Google Drive or Dropbox folder link.
Do NOT enter passwords, API keys or access tokens in this form. Where we need them, we will send you a secure link.
Are you a clinic or a hospital?*
Clinic: outpatient only, runs on our shared domain.
Hospital: in-patient wards, lab and pharmacy, on your own domains.
Options #1: Clinic
Option #2: Hospital
Identity
How patients will recognize you.
Organisation name* ________________________________
Exactly as it should print on prescriptions and receipts.
Short display name: ______________________________________
Shorter name for page headers. Leave blank to use the full name.
Banner title / tagline*: ________________________________
Shown on your landing page, e.g. “Trusted care, on every floor.”
About your organisation* ____________________________________
A short paragraph patients will see on your site. Plain text or simple HTML.
Owner and point of contact
The owner receives the first admin login.
Owner full name* _____________________________
Owner email* _____________________________
Login details are sent to this address.
Owner mobile*: ________________________
Format: +91 followed by 10 digits, no spaces, e.g. +919876543210
Point of contact name* ____________________________
Whom we call with questions during onboarding. Can be the owner.
Point of contact role / designation*: _________________________________
Point of contact phone* __________________________
Format: +91 followed by 10 digits, no spaces, e.g. +919876543210
Point of contact email* _______________________
Expected number of staff + doctors at go-live* _________________________
Public contact details
Shown to patients on your site, prescriptions and receipts.
Support email*: ___________________________
Support phone*: _________________________________
Format: +91 followed by 10 digits, no spaces, e.g. +919876543210
Help email*: _______________________________
Website URL (optional): ____________________________
Starting with https://
Social media links (Optional)
One per line, e.g. “Instagram – https://instagram.com/yourclinic“. Platforms: X, LinkedIn, Facebook, Instagram, YouTube, Other.
Address
Your registered location.
Address line 1*: ______________________________
Address line 2: ______________________________
City*: ___________________________
State*: ___________________________
Pincode*: ___________________________
4–10 digits, numbers only.
Country*: _______________________________
Branding
Images: PNG, JPEG, WebP or SVG, at most 5 MB each and 16 MB in total. Skip anything you don’t have yet. We use defaults and you can change them later.
Link to a shared folder with your images __________________________
Google Drive or Dropbox link shared with our onboarding team. Include:
• Logo: square, transparent PNG, at least 512×512
• Favicon: PNG or SVG, 64×64 (not ICO)
• Banner: wide, at least 1600×400
• Staff login background (optional): landscape image
Messaging (email, SMS, WhatsApp)
If you choose No, notifications go out from the platform’s shared sender. For any Yes, we will send a secure link to collect passwords and keys. Do not enter them here.
Send email from your own address?*
Options #1: Yes
Options #2: No
Sender email address (If Yes, e.g. noreply@yourclinic.com) : __________________________
WhatsApp notifications?*
Option #1: Yes – MsgEasy
Options #2: No
WhatsApp business phone number: ________________________
If Yes. With country code, no spaces, e.g. +919876543210
Online payments
Patients can pay consultation and service fees online through Razorpay. You will enter your Razorpay keys yourself in the EMR’s Payment settings after go-live, so do not share them with us.
Enable online payments?*
Options #1: Yes
Options #2: No
Business name registered with Razorpay
If Yes: _______________________
Staff and doctors
Prepare a CSV with one row per person and these columns:
name, mobileNumber, email, roleName, speciality, registrationNumber, qualifications
Link to your staff CSV
Google Drive or Dropbox link shared with our onboarding team. You can also send it later.
_______________________________________________
Prescription and EMR templates
Link to your existing prescription or SOAP-note templates
Optional. Word or PDF files in a shared folder. We digitise them for you.
______________________________________
Template topics to set up
Optional, e.g. “Diabetes follow-up”, “Post-op orthopaedics”.
_______________________________