Clinic Appointment Request

Clinic Appointment Request

Kindly fill out this form to set a face-to-face appointment for a consultation and/or procedure in one of our clinics.
Required Service
Name of Patient

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Sex
Contact Number
Please make sure to correctly enter your active contact number.
Email Address
Please make sure to correctly enter your active email address.
Care+Center Clinic Branch
Mode of Payment
Name of HMO Provider
Kindly note that each clinic branch has different HMO affiliations. Also, all transactions are subject to approval by your HMO provider on the day of your visit.
Name of HMO Provider
Kindly note that each clinic branch has different HMO affiliations. Also, all transactions are subject to approval by your HMO provider on the day of your visit.
Name of Doctor and/or Specialty
You may list down more than one doctor.
Note: You may refer to this link for the schedule of our doctors https://carecenter.clinic/doctors.
Test/Procedure
You may list down more than one test/procedure.
IMPORTANT

Please take note that only the following tests are on an appointment basis:
- 24-Hour Holter Monitoring
- 2D Echo
- Ambulatory BP Monitoring
- Duplex Scan
- Treadmill Stress Test
- Congenital Anomaly Scanning (CAS) - Obstetrics
- Doppler Ultrasound - Obstetrics
- 3D4D Ultrasound - Obstetrics
- Breast Ultrasound
- Transrectal Ultrasound (Male)
- Soft Tissue Ultrasound
- Chest Ultrasound
- Ultrasound of the Aorta
For COVID-19 testing, you may set an appointment through this link: https://carecenter.clinic/carecenter-covid-19-test-clinic-payment.

Tests/procedures that are not mentioned above are available on a first-come-first-served basis only.
Preferred Date of Appointment

MonthDayYear
DATA PRIVACY NOTICE

The request for personal information on this online form is done with the sole purpose of processing and managing your request. In accomplishing the information requested, you agree that Metro Sanitas Corporation and/or its subsidiaries or shareholder companies will process this Personal Information relating to you. Such processing of Personal Information may include its collection, recording, updating, modification, retrieval, use, and retention. You are also consenting to:

1. Making your Personal Information available to the relevant employees of Metro Sanitas Corporation, its subsidiaries or shareholder companies, and any service provider that may be involved in the process and management of this event;

2. The processing of your Personal Information for generating statistical data relevant to this specific activity;

3. The retention by Metro Sanitas Corporation of your Personal Information for the period necessary for the purpose of this request. We will dispose of your Personal Information upon the lapse of the Personal Data Retention Period in accordance with applicable laws and regulations. You are entitled to certain rights in relation to the Personal Information that may be collected from you, including the right to access, correction, and object to the processing of the same. Your information will be held securely and will not be made available to third parties other than the ones required to provide this service without your expressed consent.

By ticking the checkbox below, you hereby certify that you understand the foregoing and that you are giving your consent to the processing of your Personal Information and Sensitive Personal Information under the terms and conditions provided above, and to contact you in case it is required to process your request.
Required
How did you know about Care+Center? (You may select more than one)

Other (Please specify)
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