Client Registration

Vision Care Client Registration

By completing our client registration form you will be redirected to our client assessment form to complete your registration. After a review, you will be informed as to your next step which will include accommodation, use of our EMR (electronic medical record ), and payment options.

Our EMR system is to help us to help you if you have a medical emergency and is not a requirement for your stay in Barbados or using our services.

It is only a precaution.

Our Services are personalized. In order for us to offer the best care and Bajan experience, we asked you to have a meeting with us. It is not a requirement.

Registrant First Name *
Registrant Last Name *
Registrant Address *
Street Address
Address Line 2
City
State / Province / Region

Zip / Postal Code
Country
I am registering for *
Please select
Registrant Pic *
Person to be register Name *
Person to be registered PIC *
Drop your file here or click here to upload.You can upload up to 1 files.Upload limit exceeded. You can upload only 1 files.
Person to be register Address *
Street Address
Address Line 2
City
State / Province / Region

Zip / Postal Code
Country
Email *
Confirm Email *
Please select all services you will need *
Accommodation
Social integration into a bajan family
Group Living
Group activates
Health monitoring
Activities for seniors
Medical care
Independent Living
This will help ous to create your senior care package
Would you be using our EMR system *
Yes
No
Electronic Medical Record
How long will you be staying with us *
Days, Months, Years
Who will Be Paying *
Payment Method
How will you be paying for our services
Source Of Funds
Any Request
About registered person
Home Phone #
Cell Phone #
Password *
confirm Password *
Weak Password
Password not entered
Strength Indicator
No Medical Information Required
Access to this restricted area will be granted after your meeting and payment have been received.
Medical Information Required
By registering as a client you will need to enter the registered person's medical information in our EMR (Electronic Medical Records) This will allowed doctors in Barbados to understand their medical history and keep an updated record. Access to this restricted area will be granted after your meeting and payment have been received.
You must accept our Terms and Conditions to proceed.Click here to view.
Honeypot *

Vision Care Client Registration

Our Services are personalized. In order for us to offer the best care and Bajan experience, we asked you to have a meeting with us. It is not a requirement.

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Client Registration

Vision Care Client Registration

Our Services are personalized. In order for us to offer the best care and Bajan experience, we asked you to have a meeting with us. It is not a requirement.

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