Bloom Buddy Telehealth Onboarding Form for Service Providers
We are always looking for Service Providers like you to onboard our platform. You can sign up your company/entity to the Bloom Buddy telehealth platform using this form. Once you submit the form, you will receive correspondence from our team within 48 hours on next steps to onboard you to the platform. Complete the form below to begin the onboarding process to the Bloom Telehealth platform.
Organisation name
Corporate Email
Corporate website
Official Phone Number
Contact Person
(Document 1) Upload any relevant document to verify organisation's license to deliver service
Select a File
Upload any relevant document to verify organisation's license to deliver service, if you have any additional documents to upload
Select a File
Upload any relevant document to verify organisation's license to deliver service, if you have any additional documents to upload
Select a File
(Document 4) Upload any relevant document to verify organisation's license to deliver service, if you have any additional documents to upload
Select a File
Services rendered
Corporate Profile (About Business)
License/Certificate Number ( if applicable)
License Number expiration date
How did you hear about us?
Direct invitation from Bloom Buddy
Colleague / Other Professions
Social Media
Othe
Location of Business
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