NHI Patient Registration If you live on the Orange Walk District and have Social Security Card, then you qualify to register and enjoy all of NHI services. Fill in the form below to get started. Please enable JavaScript in your browser to complete this form.Social Security Number *9-digit Social Security Number eg. 000123456Name *FirstMiddleLastDate of Birth *Enter DOB as day/month/year, eg. 31/01/1971Sex *MaleFemaleOtherDistrictOrange WalkCorozalBelizeCayoStann CreekToledoCity/Town/VillageEnter the name of your City, Town, or Village where you liveConsent *YesI understand that the information I provide on this form will be used to register me as a new client. I declare that the information I provide on this form is true, complete, and accurate to the best of my knowledge. I consent to the collection, use, and disclosure of my personal information as described therein.Send Your Request To Register Call Today +501 620 1013 9 Asuncion Street, Orange Walk Town Become an NHI Member with us! Register Now
