Create Your Account

Please provide following information in-order to proceed with registration.

Your personal information that you'll be providing here will be stored in an encrypted database and will only be used to uniquely identify clinical information related to you for clinical purposes only. Your information provided here will never be available to a third party. Read our privacy policy to learn more on how we treat your personal information.

First name

Last name

Select your gender

Your email (Should be a valid email)

Your phone number (mobile or land phone)

Your birthday in DD/MM/YYYY format

Your national identity card (NIC) number

Your address

Your password (Can contain letters or numbers)

Retype your password