Become a Registered Provider of PROMED

Please fill this form to start the registration process as provider of PROMED.

Registered Provider Registration
Applicant details:
  
Commercial business information:
  
Trade or company name * Company’s main activity
Partnership’s legal certificate * Types of clients it has
Legal representative * Number of employees
Representative’s ID *

Awarded certifications
Company’s phone number *  
Company’s P.O. Box *  
Company’s website Member category
Company’s email address *
 
  
Company’s physical address *
Contacts’ information:
  
Province *
 General Management
Canton * Sales Management
District * Other contact
 
      * Required field

Cut medical & dental costs up to 70% and still get better and safer attention than home

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Calidad certificada

Calidad certificada