Senior Care Enrolment

Which Sibex service would you like to enrol for? *

If you selected Senior Care Plan, choose package below (Leave blank if not applicable

Full Name *

Email *

Phone Number/Whatsapp *

Country of Residence *

Beneficiary (elderly loved one)

Please provide details of the elderly one receiving care .

Beneficiary Full Name *

Age *

Home Address in Lagos *

service Senior of

Emergency Contact in Lagos *

Relationship to Beneficiary *

Select Care Plan

Important Service Terms

Please review Sibex service expectations, scope of care, emergency limitations, payment terms, and communication policy before proceeding.

Consent and Agreement *

I confirm that the information provided is accurate to the best of my knowledge
I understand that Sibex home-based care is subject to professional clinical judgment, and hospital referral or emergency transfer may be recommended where medically appropriate.
I acknowledge Sibex’s Terms of Service, Medical Disclaimer, and Privacy Policy
I consent to reasonable communication, care coordination, and health-related administrative processing necessary for service delivery.
I voluntarily authorize Sibex to coordinate care for the named beneficiary

By typing your full legal name below, you confirm your informed and voluntary agreement to Sibex’s service process, legal policies, and care coordination framework.

Legal Signature (Type Full Name) *

By typing your full legal name below, you confirm your informed and voluntary agreement to Sibex’s service process, legal policies, and care coordination framework.

Final Confirmation

I confirm that this submission represents my informed and voluntary agreement

Payment confirms acceptance of the selected service arrangement and Sibex onboarding terms