Online Booking by Unihealth-Parañaque

What is your name?*

PrefixFirst NameMiddle NameLast Name
Do you already have a physician from Unihealth-Parañaque? *
Is this your first appointment or a follow-up? *
Company Name
Do you fall under the following categories?
How old are you?*
What is your Date of Birth?*

MonthDayYear
Date
What is your sex?*
What is your current Civil Status?*
What Citizenship do you hold?*
What is your E-mail address? (Please provide your most active one, as is where we will send you a copy of your information and where we will send you needed documents to confirm your appointment.)*
What is your Mobile Number?*
Format: 0000-000-0000.
If you have a Landline instead of a Mobile, put 0 across the entire field above and provide your Landline Number in the field below. (Not Required)
Format: 0000-0000.
What is your present Address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the name of the person we can call in case of Emergency? Please let us know your relationship to this person. (Ex. Henry Rivera Sr., Father)*
Please provide us with the Contact Number of your provided Emergency Contact.*
Format: 0000-000-0000.
I would like to receive the latest updates and promos from Unihealth-Parañaque.*
I agree to provide Unihealth-Paranaque this necessary data.

ConsultationProcedureBoth
Do you have a preferred or current physician in Unihealth-Parañaque? If so, please provide us with their name below. If not, leave this section blank.
Consultation*
YesNoStill do not know
How many weeks are you pregnant?
Please indicate your chief complaint:
How many days has it been since you've experience this illness?*
Radiology Services
Laboratory Services
Multi-Specialty Diagnostic Center
Rehabilitation Center
Dialysis Center
ENT-VHS
Eye Center
Digestive Endoscopy Center
Pulmonary
Wellness Packages
Promos and Packages
COVID-19 Tests
I am in need of an Outpatient Service not currently listed above, I have written the service I need below; please contact me for further information.
Please upload your Doctor's Request Form*

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Please indicate the procedure that you're requesting?

Take note! Schedule is still subject for availability. Please wait for a call/email confirmation of your appointment within two (2) business days. We will also collect more specific information about your case or the type of service you need.
Please select the date you prefer.*

MonthDayYear
Date
Morning (AM)Afternoon (PM)

GCashHospital Cashier PaymentHMO/InsuranceBank DepositCash (Thru the Clinic Secretary)
For GCash Payments, please make the payment to:
Our Hospital Cashier accepts payments in the form of Cash, Debit Card, Credit Card, or Manager's Check.

ACCT NAME: Unihealth-Parañaque Hospital and Medical Center, Inc.

NO: 1531-0065-73
For HMO/Insurance payments, please provide the name of your provider.
If you still do not have a valid LOA, please visit the HMO Dept at the 4th Floor
Attach Proof of Payment (Screenshot of GCash Transaction / Bank Transaction or Deposit Slip / If LOA, must indicate the name of the hospital)

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Should be Empty: