I NEED TO CONSULT WITH MY DOCTOR
As a precautionary measure to address crowd concerns at the hospital, we highly encourage all patients seeking doctor's consultation to set an appointment online.

As a response to the limitation of medical consultation services, the hospital is creating this online platform to allow patients and doctors communicate remotely and for doctors to initially evaluate and screen patients accordingly.

Please note that confirmation of appointments is not guaranteed. Factors affecting confirmation of appointment includes availability of doctors and urgency of chief complaint, and specifics of the the information you will provide in this form.

Once your request for Appointment is accepted the hospital will send you a feedback either by EMAIL or TEXT MESSAGE for the next steps to be done surrounding your request for appointment. Depending on the urgency of your chief complaint you may either be scheduled to come to the hospital or be provided with a ZOOM LINK for live video call (teleconsult)

Make sure to provide correct and factual details to questions below.

𝑰𝑡π‘ͺ𝑢𝑴𝑷𝑳𝑬𝑻𝑬 𝑫𝑬𝑻𝑨𝑰𝑳𝑺 𝑾𝑰𝑳𝑳 𝑡𝑢𝑻 𝑩𝑬 𝑷𝑹𝑢π‘ͺ𝑬𝑺𝑺𝑬𝑫.
𝑷𝒍𝒆𝒂𝒔𝒆 π’Žπ’‚π’Œπ’† 𝒔𝒖𝒓𝒆 𝒕𝒉𝒂𝒕 π’šπ’π’– π’„π’‰π’†π’„π’Œ π’šπ’π’–π’“ π’†π’Žπ’‚π’Šπ’π’” 𝒇𝒐𝒓 𝒖𝒑𝒅𝒂𝒕𝒆𝒔 𝒂𝒏𝒅 π’π’π’•π’Šπ’‡π’Šπ’„π’‚π’•π’Šπ’π’π’”.

For more details you may call our OPD HOTLINE at 09175680005

π—œπ—™ 𝗬𝗒𝗨'π—₯π—˜ π—¦π—˜π—˜π—žπ—œπ—‘π—š 𝗨π—₯π—šπ—˜π—‘π—§ 𝗔𝗑𝗗 π—˜π— π—˜π—₯π—šπ—˜π—‘π—–π—¬ π— π—˜π——π—œπ—–π—”π—Ÿ π—”π—§π—§π—˜π—‘π—§π—œπ—’π—‘ π—£π—Ÿπ—˜π—”π—¦π—˜ π—–π—”π—Ÿπ—Ÿ 𝗒𝗨π—₯ π—˜π— π—˜π—₯π—šπ—˜π—‘π—–π—¬ π—›π—’π—§π—Ÿπ—œπ—‘π—˜ π—œπ— π— π—˜π——π—œπ—”π—§π—˜π—Ÿπ—¬ 𝗔𝗧 𝟬𝟡𝟭𝟳𝟱𝟲𝟴𝟬𝟬𝟱𝟰
Sign in to Google to save your progress. Learn more
Email *
COMPLETE NAME (Kompletong Pangalan) *
GENDER (Kasarian) *
AGE (Edad) *
NATIONALITY *
OCCUPATION (Trabaho) *
COMPLETE ADDRESS (Please indicate Zone and Baranggay) *
Please indicate Philhealth Member Details and other HMO (If any) *
Required
MODE OF TRANSPORTATION TO WORK (Kasano ka nga mapmapan iti trabaho or anya iti lugluganam nu rumrumwar ka?) *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms