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ShareYrHeart Clinic Franchise Application Form

Thank you for your interest in becoming a ShareYrHeart Clinic Franchise Partner. Kindly fill out the details below.
All information will be kept confidential.

Applicant Details

Full Name

Date of Birth

Mobile Number

Email ID

Residential Address

State

City

Educational Qualification

Professional Background

Proposed Franchise Location

City

Area/Locality

Property Address

Ownership Status

OwnedRentedLease

Available Space (in sq. ft.)

Type of Area

UrbanSemi-UrbanRural

Accessibility

Parking AvailablePublic Transport Nearby

Infrastructure Details

No. of Rooms Available

Consultation RoomsTherapy RoomsReception/Waiting Area

Internet Connectivity

YesNo

Power Backup

YesNo

Equipment (if any)

Willing to Modify as per Brand Standards

YesNo

Operational Capability

Investment Capacity (Approx)

₹

Expected Man/Woman Power

PsychologistPsychiatristCounselorAdminReceptionist

Involvement Level

Full-time OperationalManagerial/Supervisory Only

Preferred Launch Date

Legal & Compliance

PAN Card CopyAadhaar Card CopyGST Registration (if applicable)Business Registration / LicenseTrade License / Local Municipality Clearance

Alignment with ShareYrHeart

Are you willing to follow ShareYrHeart's protocols and mental health ethics?

YesNo

Are you open to undergo ShareYrHeart's training & onboarding process?

YesNo

Why do you wish to open a mental health clinic?

0 / 1000 words

Optional Attachments

Clinic Space Photographs (max 5 files)

Layout/Blueprint of Space (max 2 files)

Reference Letter (if available) (max 1 file)

Declaration

I confirm that the information provided above is true and accurate to the best of my knowledge. I understand that submission of this application does not guarantee franchise approval.

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