eDialysis - Dialysis Treatment made easy

Center Info
User Info

Centre Type: *

Centre name: *

Address: *

Postcode: *

City: *

State: *

Phone: *

Fax:

Email: *

Website:

Authorised User

This info will be use to create an account for the system.

Name: *

Phone: *

Email: *

If auth user and center manager same?

Centre Manager

This info will be display at centre directory.

Name: *

Phone: *

Email: *