Fertility Center Registration | Hitaishi Healthcare

🏥 Basic Information

Tell us about your fertility center

Center Name *

Registration Number *

Establishment Year *

Center Type *

Description *

0/10 characters

Logo (JPG/PNG, max 2MB)

📍 Location Details

Where is your center located?

Country *

State *

City *

Area/Locality

Full Address *

Pincode *

Latitude (GPS)

Longitude (GPS)

📞 Contact Information

How can patients reach you?

Primary Phone *

Alternate Phone

Email Address *

Website URL

Emergency Contact

Supported Languages

👨‍⚕️ Medical Staff

Add at least one doctor to your team

🛠️ Services & Facilities

What services do you offer?

Select Services *

IVF

IUI

PGD

Surrogacy

Egg Freezing

Embryo Freezing

Sperm Freezing

Counseling

Facilities *

Operation Theater

Ultrasound

Lab

Cryobank

Pharmacy

Insurance Accepted

Cashless

Reimbursement

Corporate

📊 Success Rates & Pricing

Share your center's metrics

IVF Success Rate (%)

Total Cycles Completed

Years of Experience

Consultation Fee (₹)

IVF Cost Range (₹)

IUI Cost (₹)

Professional Certifications

Awards & Recognition

Document Upload

License Certificate *

Click or drag to upload

JPG, PNG, PDF (Max 2MB)

Doctor Certificates (Multiple)

Click or drag to upload

JPG, PNG, PDF (Max 2MB each)

Accreditation Documents (Multiple)

Click or drag to upload

JPG, PNG, PDF (Max 2MB each)

Official ID Proof *

Click or drag to upload

JPG, PNG, PDF (Max 2MB)

🔐 Account Setup

Create your login credentials

Username *

Password *

Confirm Password *

I agree to the Terms & Conditions *

I agree to the Privacy Policy *

📋 Review & Submit

Please review your information before submission

✓

Registration Submitted!

Thank you for registering with Hitaishi Healthcare.

Our admin team will review your submission and notify you within 2-3 business days.

A confirmation email has been sent to