1 — Partner type

Which partner type best describes you? *

Pick the closest match. We will fine-tune during the review call.

Source-country referral partnerClinic, doctor, diagnostic center, healthcare connector, or community advisor in Oman or the GCC.Destination concierge teamLocal concierge, fixer, or coordinator in Bangalore or another destination city.Hospital or international patient departmentHospital, IPD, or hospital-affiliated coordinator able to respond to structured case packets.Accommodation providerApartment, serviced apartment, hotel, or family-stay provider with foreign-guest readiness.Interpreter / translatorArabic, English, Malayalam, Hindi, or other interpreter able to support medical visits.Transport vendorAirport pickup, hospital transport, or daily driver coverage in the destination city.Food / catering providerHalal, Arabic-friendly, or specialized-diet food provider supporting medical-travel families.

2 — Basic details

Your name *

Organization name *

Country *

ISO country code, e.g. OM for Oman, IN for India.

City *

Phone (WhatsApp preferred) *

Email *

Website or social profile

Preferred language for communication *

3 — Professional background

Current role / title

Years of relevant experience

Languages spoken

Comma-separated. Example: Arabic, English, Malayalam.

Countries you serve

Comma-separated ISO codes or names. Example: OM, AE, IN.

Healthcare experience

Medical-travel experience

Existing network or partnerships

5 — Ethical commitments

Every AfiyaBridge partner agrees to the following before joining the network. Please review and acknowledge each item.

I will not provide clinical advice on behalf of AfiyaBridge unless I am a licensed practitioner acting in that capacity.

I will not promise a specific clinical outcome — outcomes depend on doctors, hospitals, and the patient's condition.

I will not quote hospital prices on my own. Hospital pricing belongs to hospitals.

I will not collect treatment funds from patients on the hospital's behalf without proper written authorization.

I will protect patient privacy and obtain explicit consent before sharing any records.

I will use AfiyaBridge's approved intake, consent, and communication workflows for any case routed through the network.

7 — How did you hear about us?

How did you hear about AfiyaBridge? *

Please tell us more

Referral code (if any)

If a partner shared a code with you, paste it here.

8 — Anything else you'd like us to know?

Why would you like to partner with AfiyaBridge?

Up to 500 characters.

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