Tumaini Haven · Patient Enrolment

Step 1 of 4

About you

Match what's on your Kenyan ID or passport exactly — even small typos can slow things down. We need every field marked *.

Your full legal name

Date of birth

We use this to verify with insurers.

Sex (assigned at birth)

Required for clinical safety reporting.

ID number

7–8 digits for National ID, or your passport letters + numbers.

Your phone

+254

We'll only call about your treatment.

Backup phone

+254

If we can't reach you on the first.

Email address

We'll send a signed copy of your consent here.

County

Town, area or estate

Nearest landmark helps our delivery team.

Step 2 of 4

Your care circle

Treatment is easier with support around you. Who's helping you through this, and who's prescribing?

Someone we can talk to Optional

A spouse, child, sibling or friend we can reach when we can't get through to you. They'll only hear what you've consented us to share.

Their full name

Their phone

+254

Relationship to you

Their email (optional)

Your prescribing doctor

The clinician who put you on this medication. We coordinate the paperwork with their office for you — you won't need to chase them.

Doctor's name

Doctor's phone or clinic line

+254

Where's the clinic?

Hospital or clinic name

Step 3 of 4 · The decision

The agreement

Take a moment with this. You're authorising Tumaini Haven to share information with your insurer, pharmacy and treating team so we can coordinate your care. The full terms run below — please read them.

First — who's filling this out? *

It's me, the patient

I'm signing for myself

A caregiver

Family or legal guardian

A doctor

Signing on patient's behalf

A PSP nurse

Helping with enrolment

The full terms · please read through

Choose who's filling this out above — the terms will appear here once you do.

Scroll through to continue ↓

Final step

Your signature

Type your full legal name, then sign below with your finger (on phone) or mouse. Under the Kenya Information & Communications Act, this signature has the same legal effect as a handwritten one.

Communication preferences

Optional — choose how we may reach you with non-essential updates. This will not affect your care or the programme-essential messages we must send (e.g. delivery coordination).

SMS (text message) WhatsApp

We'll use the phone number you gave above.

Email Phone call

Type your full legal name

Sign below

Use your finger on touch screens, mouse on desktop.

Quick check — does this look right?

Need to fix something? Go back to start →

A signed PDF copy of this consent will be made available for download. By submitting you confirm the information above is true to the best of your knowledge. Privacy notice ↗ Data rights form ↗

Treatment is hard enough.
The paperwork shouldn't be.

Which medication did your doctor prescribe?

About you

Your care circle

Someone we can talk to Optional

Your prescribing doctor

The agreement

Your signature

Quick check — does this look right?

Welcome to Tumaini Haven.

What happens now

We'll be in touch

We start working behind the scenes

Your medication gets moving

You won't be doing this alone

Need to reach us before then?

Which medication did your doctor prescribe?

About you

Your care circle

Someone we can talk to Optional

Your prescribing doctor

The agreement

Your signature

Quick check — does this look right?

Welcome to Tumaini Haven.

What happens now

We'll be in touch

We start working behind the scenes

Your medication gets moving

You won't be doing this alone

Need to reach us before then?

Enrolment received