Private911.App

New Hospital Registration

Hospital Name*

Hospital Health Registration Number (COFEPRIS)*

Hospital Address

Street/Number*

Neighborhood*

City*

State*

Postal Code*

Email Address (Main Contact)*

Code Phone*

Phone Number (Hospital Main Line)*

Website*

Primary Contact Person

Full Name*

Position/Title*

Phone Number (Direct Line)*

Email Address*

Emergency Contact for Service Operation

Full Name*

Phone Number (Emergency Front Desk Number)*

Email Address for Emergency Attention*

Recommended Front Desk WhatsApp (Optional)

Emergency Response Capabilities

Does your hospital have 24/7 emergency services?

Yes No

Does your hospital have an ambulance service?

Yes No

Number of Ambulances*

Does your hospital have an OUTSOURCING ambulance service?

Yes No

Response Radius (How far can your Ambulance Service Assist a Patient)*

*Click on the map to select the location of the hospital.

Accreditations and Certifications

Joint Commission International (JCI)

Consejo de Salubridad General (CSG)

Canadian Accreditation

ISO 9001 Certification

Other International or National Accreditations

Additional Information

Please provide any additional comments or information you believe is relevant for the registration process

Promoter*

Terms and Conditions: By submitting this form, you agree to the Terms and Conditions of the Private911.App including compliance with Mexico’s healthcare regulations and privacy laws, such as the Federal Law on Protection of Personal Data Held by Private Parties (Ley Federal de Protección de Datos Personales en Posesión de los Particulares). You also consent to the use of your hospital’s data for the purposes outlined in our Privacy Policy.

I agree to the Terms and Conditions and the Privacy Policy.

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New Hospital Registration

Hospital Address

Primary Contact Person

Emergency Contact for Service Operation

Medical Services Offered

Emergency Response Capabilities

*Click on the map to select the location of the hospital.

Accreditations and Certifications

Additional Information