VOAS Patient Module

Welcome to the VLDMC Online Appointment System

Your easy access to convenient, safe, and reliable outpatient healthcare.
Essential Patient Information

Please enter the correct details so that we can efficiently assess your particular case and get in touch with you to confirm your schedule.
Complete Name of Patient

First Name(s)Middle NameLast NameSuffix
Complete Address of Residence

Complete Street Address and Barangay

Street Address Line 2

Town/CityProvince

Postal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearBirthdate
Sex
Marital Status
Email
Enter your email address.
Phone Number
Enter your mobile phone number.Format: (0000)-000-0000.
- Contact Person In Case of Emergency
  
  First NameLast Name
- Phone Number
  Emergency Contact Phone NumberFormat: (0000) 000-0000.
- Relationship to Patient
  Please choose one from the list.

Let us know how we can help

Please indicate your specific purpose of visit and select the service(s) that you would want to avail yourself of. You may select multiple services based on your needs.
Please state the main reason for your visit
Please specify your health complaints, symptoms, and/or signs of pain and discomfort
What service(s) would you like to avail yourself of?

Referral Form / Physician's Orders Uploader

Please upload a digital copy of the referral or order form that your physician issued you using the form uploader below.
Upload a digital copy of the referral form/slip that was issued to you by your physician

Please send us a photo of the referral form issued by your doctor using your mobile phone's rear camera and help our team evaluate the services that fit you best.
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Other Medical Services and Procedures

Please select below the specific medical service(s) and/or procedure(s) that your would want to avail yourself of.
Please select the specific service that you are interested in on the dropdown below:

Can't find the service(s) you're looking for?

Specifying the service you require allows us to provide the best possible assistance.
Please enter the specific service(s) that you would want to avail yourself of in the field provided below:

Primary purpose of Medical Certification

Please explain briefly the main objective of your request for a medical certificate.
Provide the specific reason for your medical certification request
Reason for Need of a Medical Certificate

When was your most recent medical consultation with our physician?

Please enter the date when you last availed yourself of a medical consultation with one of our physicians. This will help us facilitate your request for medical certification faster.
Date of most recent consult with our in-house physician

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate of Most Recent Medical Consultation with your Physician at VLDMC

Appointment Scheduler

Please note that the appointment slot you choose will be treated as provisional until it is confirmed. After completing and submitting the digital form, a member of VLDMC's Medical Concierge Team will promptly reach out to you directly to confirm your schedule.
Please choose your preferred schedule of visit by choosing a specific date and time below
Please choose your preferred schedule of visit by choosing a specific date and time below
Preferred Schedule of Regular Medical Consult

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Preferred Schedule of Medical Psychological Counselling

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
- VOAS Privacy Notice
  
  In compliance with the Data Privacy Act of 2012 (RA 10173), Vicente L. Danguilan Memorial Clinic (VLDMC) is committed to protecting your privacy. By using the VLDMC Online Appointment System (VOAS), you acknowledge and agree to the following terms:
  - Collection of Data: We collect your personal details (e.g., name, contact information, date of birth) and sensitive personal information (e.g., medical complaints, requested medical specialty, or diagnostic services) necessary to schedule and facilitate your outpatient appointment.
  - Purpose of Processing: Your data will be used exclusively to process your appointment request, send reminders, manage clinic queues, and coordinate your care within our multi-specialty clinic and diagnostic center.
  - Storage and Protection: VLDMC implements strict technical, organizational, and physical security measures to ensure your health information remains confidential and protected against unauthorized access or disclosure.
  - Data Retention: Your data will only be retained for as long as necessary to fulfill the medical purpose or as required by prevailing Department of Health (DOH) medical record retention policies.
  - Your Rights: You retain the right to access, correct, object to, or request the erasure of your personal data, subject to legal and medical record limitations. For data privacy concerns, you may contact our Data Protection Officer at danguilan.clinic1947@gmail.com.
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