Apply to Join CloudClinic

Doctors and clinic staff may submit their professional details for administrator review.

Submitting this form does not create an active account yet. The CloudClinic administrator will review your application, verify details as needed, and activate credentials only after approval.

Questions about your application? Email cloudclinic.ph@gmail.com.

Application Type

Choose the role that best describes how you want to join CloudClinic. The administrator will review details before activating any account.

Applying as Requested Username If other role, please specify

Personal & Contact Information

Email Phone Last Name First Name Middle Name Suffix Birthday Current City / Area Profile Picture

Professional Details for Doctors / Licensed Clinicians

These details may be used for profile review and, when applicable, document templates after administrator approval.

Department Specialization Subspecialization License Number License Expiration PTR Number E-signature Specimen

Staff / Secretary Work Details

For secretaries, clinic assistants, encoders, coordinators, and non-doctor staff. These help the administrator assign the right access and training.

Desired Staff Role Preferred Department / Doctor Assignment Apply under a doctor's clinic Selected doctor's clinic Highest Educational Attainment Relevant Work Experience EMR / Computer Skills Communication Channels Preferred Work Setup Availability / Schedule Expected Start Date Supervisor / Referrer Tasks you can handle Confidentiality acknowledgement

Attachments & Notes

Credentials / Notes Credential attachments