Doctor Portal @ FHN3

Please fill in the Tax Reg. No. if your clinic is GST registered.
Fullerton Healthcare Group will reimburse for the services rendered within 45 - 60 days upon the date of submission of claims.

Provider Information

Provider Name*

Provider Type*

Biz Reg. No.

Provider Region*

Tax Reg. No.

Phone No.*

Fax No.

Email Address*

Operating Hours

Monday to Friday*

Saturday*

Sunday*

Public Holiday*

Business Contact

Billing Contact

Postal Code*

Address Line 1*

Address Line 2

Address Line 3

Doctor Information

Bank Account