BARANGAY MAGALLANES MEDICAL CARAVAN

FULL NAME*

First NameMiddle NameLast Name
Date of Birth *

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
E-mail Address*
example@example.com
PHILHEALTH NUMBER*
Please upload your Phil Health ID here, Thank you!

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PRIVACY NOTICE
In compliance with the Data Privacy Act of 2012 (RA 10173), Barangay Magallanes is committed to protecting the privacy of your personal and sensitive personal information. This notice explains how we collect, use, and protect your data in the course of providing medical services.The health information that you provide is under the protection of the Data Privacy Act of 2012 (RA 10173).
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