Manual Patient Represented Registration

Patient Self Registration

Manual Represented Patient Registration

This field is hidden when viewing the form

Submission Date(Required)

Patient Information

Full Name(Required)

Primary Legal Guardian

Full Name(Required)

Telephone(Required)

Secondary Guardian

Please check "Yes" if you need to include a secondary legal guardian.

Yes

Secondary Legal Guardian

Full Name(Required)

Telephone(Required)

Forms Uploading

Patient Registration(Required)

Please click here to download the Registration Forms,
fill them up manually and then upload a completed (scanned) copy in the following file-upload field.

Accepted file types: pdf, png, jpg, Max. file size: 15 MB.

Registration Fees

Payment Type(Required)

Bank Transfer

Online Payment

The registration fee for patients using iMER services is a fixed rate of €150. This fee covers the administrative processing of medical registration and applies to all patients, regardless of the registration method selected. Kindly note that this fee is not refundable for any reason.

Bank Name: Eurobank
Beneficiary: iMER Medical Services Ltd
Account Number: 001-00002411
IBAN: CY42 0180 0008 0000 3001 0000 2411
SWIFT: ERBKCY2N

Please send deposit slip to iMER by fax or email.
Please remember to indicate the patient’s name as reference on the deposit slip.
Accounts Email: christina@imer.net Fax: +357 22872323

Open iMER Payments