Patient Registration

Join CFU Medical Centre - Fill out the form below to register as a new patient

First Name *

Middle Name

Last Name *

Date of Birth *

Gender *

Blood Group

Phone Number *

Email Address

Physical Address *

Occupation

Marital Status

Full Name *

Phone Number *

Relationship *

Contact Name *

Contact Phone *

Known Allergies

Medical History

Create Password (for patient portal access) Leave blank if you do not want to set a portal password now.

I consent to medical treatment and understand that CFU Medical Centre will provide healthcare services to the best of their ability.

I consent to the collection and processing of my personal and medical data for healthcare purposes and appointment management.

I have read and agree to the Terms and Conditions and Privacy Policy.

Already registered?