Lab Services Form

Facilities seeking registration under NHI Bahamas must complete and submit this form. NHI Bahamas will schedule an on-site inspection after receiving your completed form.

NHI Bahamas requires the Facility Administrator to complete this form and verify that the information provided is true and accurate. Please complete separate forms for each service that your facility offers – i.e. physician, lab, diagnostic imaging, pharmacy.

If you have any questions about the application form, please email NHI Bahamas at info@nhibahamas.gov.bs and include “Application for Assessment Form” as the subject line.

1 Facility Information

2 Professionals Listing

3 Upload Documentation

4 Submission of Application Form

PROFESSIONALS LISTING
Please include a full listing of all nursing, lab, diagnostic imaging and allied health professions staff at your facility, who are registered by a local health professionals council/board.

Please note the following: As a facility offering Lab services, you must list at least 1 licensed Medical Laboratory Technologist.
Professional 1
First Name
Last Name
Position/Professional Type
E-mail Address
Phone Number
Council/Board Licensed by
Council Registration Number
License Expiration Date
- REMOVE PROFESSIONAL+ ADD PROFESSIONAL

Business License
Drop files here or

Accepted file types: pdf, jpg.
NIB certification
Drop files here or

Accepted file types: pdf, jpg.
TIN/VAT Certificate
Drop files here or

Accepted file types: pdf, jpg.
Licenses/Certificates for all allied health professionals licensed by a local health professions council/board
Drop files here or

Accepted file types: pdf, jpg.

SUBMISSION OF APPLICATION FORM
I confirm that I am the Facility Administrator and the information submitted in this form is true, complete and accurate.*
First Name*
Last Name*

User 1

Professional 1