Facility application

Register your facility for pilot listing review.

Complete this step-by-step application. GPS location capture is required to strengthen location accuracy before admin review.

1. Choose facility category

This helps ClinicGenZ apply the right review checklist later.

Facility category *Ambulance/emergency transport is excluded from early scope.

Main services offered *

2. Facility details

Provide details for admin review and future public listing preparation.

Legal/registered name *

Public display name *

Business/SSM number

Business entity type

Facility description *

3. Location and required GPS

Use the device/browser GPS so ClinicGenZ can review exact facility location.

State *

District *

Facility address *

Public facility phone

Public facility email

Operating hours

Manual Google Maps link

Required GPS location

Tap the button below. Your browser may ask for location permission. For best accuracy, stand at the facility location before capturing.

GPS not captured yet.

GPS is required for application review. Exact location helps reduce wrong listing/address errors. Browser GPS requires permission and HTTPS in production.

4. Authorized representative

ClinicGenZ may contact this person for verification.

Representative full name *

Role/designation *

Representative phone *

Representative email *

Category-specific licence/registration notesSecure document upload will be added when document review is enabled.

5. Future portal access

This prepares the later facility owner login and dashboard workflow.

Preferred login email *

Preferred contact method *

Future functions you are interested in

Login note: Facility Login is visible on this website, but real login will be enabled only after secure system, authentication, admin verification and account invitation are ready.

6. Review and declarations

Confirm the application summary and required declarations.

I am authorized to submit this facility application.The information provided is true and accurate to the best of my knowledge.I confirm the GPS location was captured for the facility location as accurately as possible.I understand ClinicGenZ verification is for platform listing review only and does not replace legal/regulatory licensing, registration, approval or compliance required under Malaysian law.I understand free pilot listing is subject to verification, eligibility, platform readiness and ClinicGenZ terms, and may change after the pilot period.I consent to eligible public facility information being shown in the ClinicGenZ app after admin verification.I agree to the facility portal privacy notice and terms.

Submission notice: Online submission and admin review will be introduced in stages. During early preview, submitted details may be used only for readiness planning.

Register your facility for pilot listing review.

Unsure what happens after registration?

1. Choose facility category

2. Facility details

3. Location and required GPS

Required GPS location

4. Authorized representative

5. Future portal access

6. Review and declarations