Partner Registration - MomsBed.com

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Partner Application Form

Fill in the details below. You'll need to accept our terms before review.

Nursing Home Name *

Registration Number

Total Beds *

Chief Doctor Name *

Doctor Qualification

State *

City *

Start typing to search existing cities or add a new one

Area/Locality *

Start typing to search existing areas or add a new one

Complete Address *

Pincode *

Contact Person Name *

Email Address *

Phone Number *

Alternate Phone

Additional Message (Optional)

ℹ️ Note: Payment details can be added now or later from your partner dashboard after approval.

UPI ID (for receiving payments) (Optional)

You can update this later in your partner dashboard

Upload Payment QR Code (Optional)

Upload a clear QR code image for payment verification (JPG, PNG). You can add this later from your partner dashboard.

Note: After submitting this form: