Cascade Of Hope Community Health Center

Patient Registration

Personal Info

Contact Details

Medical History

Account Setup

First Name *

Middle Name

Last Name *

Date of Birth *

Gender *

National ID Number

Blood Group

Primary Phone * Format: 07xxxxxxxx or 01xxxxxxxx

Secondary Phone

Email Address Required for account creation

Physical Address

County

Sub County

Village/Estate

Name

Phone

Relationship

Known Allergies This helps us provide safe treatment

Chronic Conditions

Insurance Type

Insurance Number

Create a password to access your patient portal

Password *

At least 8 characters with uppercase, lowercase, number, and special character

Confirm Password *

I agree to the Terms and Conditions and Privacy Policy

Important: Your registration will be reviewed by our staff. You will receive a notification once your account is approved.

Registration Successful!