RHP | Healthcare Service Provider Application

Real Test Data

Practice Onboarding Source

Care Service Provider - Vetting Stage

Service Provider Name & Surname

Service Provider ID Number

Service Provider HPCSA Number

Service Provider Discipline
Administrator
Audiologist
Biokineticist
Clinic
Diabetes Nurse Educator
Dietician
General Practitioner
Health Hub
Hospital
NGO
Nurse
Nutritionist
Occupational Therapist
Physiotherapist
Podiatrist
Psychiatrist
Psychologist
Registered Counsellor
Social Worker
Specialist
Speech Therapist

BHF / PCNS Registered Practice Name

BHF / PCNS Registered Practice Number

Group Practice Number

Registration Type

Sole Proprieter
Incorporated Company
Partnership
Other

Company Registration Number (If Applicable)

Practice Physical Address

Service Provider Direct Contact Number

Practice Contact Number

Service Provider Direct Email Address

Practice Email Address

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