Registration Form for Investment Interest in Angsamerah

Thank you for your interest in Angsamerah. We are delighted that you are interested in joining us as one of our partners.
To get started, please complete all the available fields below. We will review your form and contact you soon.


Date of Birth




Partnership Type

Organizational Site

Type of business to invest in


Which city would you like Angsamerah to open in


How much are you prepared to invest?


Where did you first learn about investing in Angsamerah?

Reason for Interest in Partnership

Specific Field of Interest in Healthcare

Experience & Knowledge

What knowledge and experience related to HIV, STIs, and Reproductive Health Services do you have?

Please fill in specific notes here, if you have any

Other Partners

Besides yourself, are there any other people who are interested in investing in Angsamerah with you?

Contact Us

Please use this form anytime to contact us with questions, or to schedule an appointment.

You can also contact us on WhatsApp or call us during clinic hours on +62 8111 368 364.