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    1. Profile

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    2. Specialties

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    3. Package

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    4. Sign-off

    NEO Doc Practitioner Digital Suite

    Join the elite digital infrastructure built for modern medical specialists. We build, secure, and manage your high-performance professional website, custom .co.za domain, secure email hosting, and targeted digital presence.

    1. Profile 2. Specialties 3. Package & Intake 4. Sign-off

    1. Professional Information

    Title

    Full Name & Surname:

    HPCSA Registration Number (MP Number):

    Years in Practice / Post-Community Service:

    Professional Contact Number:

    Preferred Professional Email:

    1. Profile 2. Specialties 3. Package & Intake 4. Sign-off

    2. Specialties & Practice Location

    Primary Medical Specialty:

    Sub-Specialties / Focus Areas (Select all that apply):

    Practice Location / Primary Suburb & City:

    Desired Website Domain / Handle Name:

    1. Profile 2. Specialties 3. Package & Intake 4. Sign-off

    3. Select Your Digital Service Tier & Intake Modules - Only Professional and Complete Tiers include the specialised forms

    Choose your infrastructure tier. If you select NEO Professional or NEO Complete, configure your custom patient intake form tabs below:

    Subscription Tier:

    Searchable Network Visibility:

    Custom Intake Form Configuration (Included for Professional & Enterprise Tiers):

    Select the specific patient onboarding tabs you require built into your digital practice workflow:

    Billing Preference:

    1. Profile 2. Specialties 3. Package & Intake 4. Sign-off

    4. Verification, POPI Compliance & Agreement

    By submitting this registration, you authorize NEO Doc to verify your active credentials with the Health Professions Council of South Africa (HPCSA).

    Full Legal Name (Confirming Authority):

    HPCSA Number Check Confirmation:

    Digital Signature:

    Date: