Patient Registration

Create your account and send your documentation

The information is used for identification, document validation, pharmacy care, legal obligations, patient protection, and traceability. Registration does not guarantee automatic approval.

DataComplementaryPathologiesAddressDocumentsProfileTerms

Criar sua conta ?Use seu e-mail real — enviaremos a confirmação por ele. O restante você completa depois, na sua área.

Cadastro rápido: só o essencial agora. Documentos, endereço e demais dados você completa quando quiser na sua área — antes da consulta.

Full Name:

CPF:

Birth Date:

Mobile Phone Number (with Area Code):

We validate by SMS after registration.

Email:

Password:

Confirm Password:

Quick Verification — Recommended

Confirm your phone and email now (fail-fast): accelerates analysis and prevents typing errors.

Phone

➕ Adiantar mais dados agora (opcional) — você também pode completar depois na sua área

Dados pessoais adicionais

Sex:

Marital Status:

Occupation:

Identification Number:

Issuer of the ID Document:

State of the Issuing Authority:

Education Level:

Phone:

Home Phone Number:

Phone for Messages:

Alternative Email Address:

2. Informações complementares ?Opcional. Ajudam no acolhimento e em programas sociais. Você pode escolher "Prefiro não informar".

Ethnicity:

Race/Ethnicity:

Sexual Orientation:

Religious Affiliation:

How did you hear about us:

Monthly individual income:

Family Monthly Income:

Family Members at Home:

Health Plan:

If you do not have a plan, write "SUS".

I am a foreigner

3. Prescritor e patologias ?Os dados do profissional estão na sua receita, normalmente junto do carimbo.

Healthcare Professional's Name:

Registration Number of the Professional:

Pathologies (ICD)

Select the (selected) pathology(s) from the list of accepted ICD codes for treatment. Verify with your prescription/medical report.

Disease / CID 1:

Year of diagnosis:

Symptoms:

Medical Condition / CID 2:

Year of diagnosis:

Symptoms:

Disease Classification / CID 3:

Year of diagnosis:

Symptoms:

Address

Search address

Search the address, or click on the map Select location

Postal Code:

Street Address:

Number:

Apartment Number:

Neighborhood:

City:

State (Abbreviation):

Country:

5. Documentos ?Envie arquivos legíveis (PDF/JPG/PNG). No celular você pode tirar a foto do documento na hora.

Send legible files (PDF, JPG or PNG)

Identification Document (Front):