Register New Clinic

Create the clinic record and the clinic owner’s private admin account at the same time. Fields marked with are required.

Clinic Information

These details identify the clinic and open its role-selection portal.

Clinic Name

Dental Clinic Association

Your clinic will remain pending until this association approves the registration.

Clinic Contact Number

Clinic Login Email

Clinic Access Password

Confirm Clinic Access Password

Private Owner/Admin Account

Only this private account can enter the owner/admin dashboard. It must use a different email from the clinic login email. All clinic notifications are sent to this private owner email.

Owner Full Name

Private Owner Phone (optional)

Private Owner Email

Private Owner Password

Confirm Private Owner Password

Association Verification Documents

All 3 documents and their reference number, issue date, and expiry date are required. PDF, JPG, or PNG only; maximum 5 MB per file.

1. Clinic Business Permit *

Permit / Reference Number *

Document File *

Issue Date *

Expiry Date *

2. DTI Registration *

Registration / Reference Number *

Document File *

Issue Date *

Expiry Date *

3. BIR Registration *

Accreditation / Reference Number *

Document File *

Issue Date *

Expiry Date *

Clinic Map Location

Click the map to place the clinic pin, or drag the pin to adjust it. The Clinic Location / Address below the coordinates will fill automatically.

Selected Latitude (automatic)

Selected Longitude (automatic)

Clinic Location / Address

The clinic-access password only opens the Dentist/Owner selection screen. The private owner password is still required to enter the admin dashboard.

Already registered? Return to Clinic Login

Register New Clinic

Clinic Information

Private Owner/Admin Account

Association Verification Documents *

1. Clinic Business Permit *

2. DTI Registration *

3. BIR Registration *

Clinic Map Location *

Association Verification Documents

Clinic Map Location