HEALTH FACILITY REGISTRY (HFR) DATA COLLECTION
HEALTH FACILITY REGISTRY (HFR) DATA COLLECTION FORM FOR OPTOMETRISTS, DISPENSING OPTICIANS AND LENS SURFACING LABORATORY
*** NOTE: All clinics with multiple branches are required to fill different forms for each of the branches not just one ***
OPTOMETRISTS AND DISPENSING OPTICIANS REGISTRATION BOARD OF NIGERIA
Board No. (SAMPLE BOARD No. OOP/1234/5678) *
Your answer
REGISTERED FACILITY NAME *
Your answer
NATIONAL FACILITY UNIQUE IDENTIFIER
Your answer
STATE UNIQUE IDENTIFIER
Your answer
CORPORATE AFFAIRS COMMISSION REG. NUMBER *
Your answer
DATE OF COMMENCEMENT OF OPERATION *
MM
/
DD
/
YYYY
ALTERNATIVE FACILITY NAME
Your answer
STATE *
LOCAL GOVERNMENT AREA *
Your answer
WARD *
Your answer
FACILITY TYPE *
Required
LOCAL GOVERNMENT SERIAL NUMBER
Your answer
PRACTICE ADDRESS/ PHYSICAL LOCATION OF PRACTICE *
Your answer
GPS COORDINATE (LONGITUDE) *
Your answer
GPS COORDINATE (LATITUDE) *
Your answer
FACILITY ADDRESS 1 *
Your answer
FACILITY ADDRESS 2 *
Your answer
CITY *
Your answer
FACILITY POSTAL CODE *
Your answer
FACILITY STATE *
FACILITY COUNTRY *
PHONE NUMBER ( OFFICIAL) *
Your answer
FAX
Your answer
FACILITY EMAIL *
Your answer
FACILITY WEBSITE *
Your answer
NUMBER OF EMPLOYEES *
Your answer
DAYS OF OPERATION *
Required
HOURS OF OPERATION *
Your answer
INDUSTRY TYPE *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service