NHIS Plan Registration Plan Form Home NHIS Plan Registration Plan Form PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameMiddle NameLast NameDate of BirthEmail AddressPhone NumberAlternate Phone NumberGenderMaleFemaleOtherNHIS NumberEmergency Contact NameEmergency Contact Phone NumberConsultation Options (Choose one)GP ConsultationSpecialist ConsultationMedical Record ReviewAdditional NoteSubmit