Provider / Panel Clinic Application

Join the eBen Assist Panel Network

Tell us about your clinic, your operating hours, and attach your licensing documents. Our credentialing team reviews every application - nothing goes live until it's approved, and no account is created until then.

  Provider Details

Your clinic's legal identity and contact information.

RM
RM
Doctor In-Charge
Bank Details (optional - for future payment setup)

  Operating Hours

Both a public summary and a day-by-day breakdown - the summary is what applicants read in a directory listing, the breakdown feeds scheduling.

Open 24 hours, every day
Monday   Closed
Tuesday   Closed
Wednesday   Closed
Thursday   Closed
Friday   Closed
Saturday   Closed
Sunday   Closed
Public Holiday   Closed

  Supporting Documents

Attach the documents your application needs. Only the four marked "Required" block submission - the rest can be added later.

Accepted formats: PDF, JPG, JPEG, PNG · Max 10 MB per file · Multiple files allowed per document.
Clinic Profile
Required
Company profile covering services, facilities and staffing.
Practising Certificate (APC)
Required
Doctor in-charge's Annual Practising Certificate.
Primary Degree (MBBS)
Required
Doctor in-charge's primary medical qualification.
Premise Registration
Required
Registration confirming the right to operate this premise.
Occupational Health Cert (OHD)
Optional
Speciality only - skip if not applicable.
Medical Report Officer (AMRO)
Optional
Speciality only - skip if not applicable.
Medical Review Officer (MRO)
Optional
Speciality only - skip if not applicable.
Insurance Policy
Optional
Often renewed later - upload if available now.
Pricing List
Optional
Often negotiated later - upload if available now.
Examiner Appointment (AME)
Optional
Speciality only - skip if not applicable.
0 of 4 required documents attached