Medical Treatment Ireland & UK - Providers - Become a Member of our Provider Network

Become a Member of our Provider Network

Simply fill in the attached form – it should only take a minute
We will be in contact to agree rates for the procedures you offer and to verify some information that will be important to Avantis members such as registration authority, facilities etc
We will also arrange a visit to you facility

Register now…!

Address and Contact Information

Please enter your information below.

Name^*: Address 1^*: Address 2: Address 3: Country^*: City^*: Telephone^*: Fax: E-Mail^*: Web: Contact Name^*: Contact Telephone^*: Contact E-Mail^*: Currency^*: Sterling
Dollar
Euro

Provider Details

Please enter your details below.

Registration
Authority: Insurance: Do you have professional indemnity or equivalent insurance? Yes
No
Number of Rooms: Type of Rooms: Aftercare: Description: Please enter the description of facility as you would like it to appear on customer quotations (should be no more than four lines)

^* Mandatory field - please complete

Avantis Health

Become a Member of our Provider Network

Address and Contact Information

Provider Details