Online Doctor Appointment Form

BHMC Online Booking System

Reminder | The schedule is still subject to 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. In case of emergency, please call our OPD at 0956-523-2574.
Name*

First NameMiddle NameLast NameSuffix
Cellphone Number*
Civil Status
Gender
Citizenship
Date of Birth*

MonthDayYear
Date
E-mail Address
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please check if you belong in any option stated*

Senior CitizenPWDBHMC's Stockholder/Dependent(s)BHMC's EmployeeNone of the above
Do you have Alagang BHMC Suki Card?*

YesNo
Do you already have a physician from BHMC?*

YesNo
If Yes, please state your physician's name
HEALTH DECLARATION FORM
Have you tested positive for COVID-19 within the past 14 days? *
Have you exposed to a COVID positive within the past 14 days? *
Do you have any of the following signs and symptoms?*

fevercoldschillscoughssore throatdifficulty in breathingdiarrheaheadacheloss of tastemuscle painloss of smellno symptoms at all
In accordance with RA11332, I certify that the above declarations are TRUE and CORRECT. I understand that any dishonest answer(s) may have serious public health implications and may be subjected to penalties. *
Service Selection

Please choose whether you are for consultation or procedure or are interested in our promos and packages.
Mode of Payment*

Cash basisHMO/Insurance Company
Note: If you are using a healthcare card/insurance payment, please make sure that this will be approved by BHMC's HMO department one day before your confirmed schedule of consultation. *
Indicate your HMO Card*
If you wish to clear your option, select the blank portion above
What service are you requesting?

ConsulationProcedurePromos and Packages
For Consultation*
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Ophthalmology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Surgery
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Dental Medicine
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Dermatology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Orthopedic Surgery & Trauma
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Neuro Surgery
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Urology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Otorhinolaryngology/Head and Neck Surgery
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Rehabilitation Medicine
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Internal Medicine
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Cardiology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Endocrinology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Gastroenterology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Geriatrics
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Neurology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Pulmonology
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Infectious Diseases
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Psychiatry
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Pediatrics
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Women's Health Center
If you wish to clear your option, select the blank portion above
Doctor's Schedule - Obstetrics and Gynecology
If you wish to clear your option, select the blank portion above
For Procedure
If you wish to clear your option, select the blank portion above
Women's Health Center

Breast UTZ - P1,404.90Mammography - P3,465
Heart/Pulmonary Station

24 HRS HOLTER MONITORING - P5,00024 HRS ABPM MONITORING - P4,300ECG - P6312D-ECHO - P4,122TREADMILL TEST - P3,000
CLINICAL CHEMISTRY

FASTING BLOOD SUGAR– P230TOTAL CHOLESTEROL – P240HDL – P305TRIGLYCERIDE– P305CREATININE– P250BLOOD UREA NITROGEN – P250BLOOD URIC ACID - P240INORGANIC PHOSPHORUS –P37050g OGCT – P48075g OGTT (NON PREGNANT)– P1,05075g OGTT (PRE-NATAL) –P950HbA1c – P1,100MAGNESSIUM – P365SGOT/AST – P315SGPT/ALT – P315TOTAL PROTEIN – P305IONIZED CALCIUM – P670CALCIUM – P305CHLORIDE – P305SERUMALBUMIN – P250BILIRUBIN(DIRECT AND INDIRECT) – P365POTASSIUM – P305SODIUM– P305LACTATEDEHYDROGENESE – P350LIPASE– 400ALKALINEPHOSPHATASE – P400AMYLASE– P400IONIZEDCALCIUM – P670
CLINICAL HEMATOLOGY

CBC w/ PC – P350ESR – P220PT (INR) – P450CLOTTING TIME – P200BLOOD SMEAR– P250PERIPHERAL D-DIMER – P4800APTT – P600BLEEDING TIME – P145
CLINICAL MICROSCOPY

ROUTINE URINALYSIS - P150ROUTINE FECALYSIS - P120URINE PREGNANCY TEST - P240FECAL OCCULT BLOOD TEST - P345
IMMUNOSEROLOGY / IMMUNOCHEMISTRY

TSH – P850FT3 – P850FT4 – P750SALMONELLA TYPHI IGG, IGM– P1,250DENGUE NS1, IGG, IGM –P1,600FERRITIN – P1,000CRP – P1,000PROCALCITONIN – P1,850SYPHILIS – P230HBSAG (QUALITATIVE) –P305ANTI-HCV (QUALITATIVE)– P483
COVID-19

COVID-19 RT PCR - P4,682COVID-19 RAPID ANTIGEN TEST - P1,348
If others, please specify:
Please specify your procedure:
Please specify your procedure for Rehab:
Upload your laboratory request*

Browse Files

Cancelof
Promos and Packages
If you wish to clear your option, select the blank portion above
Booking Appointment

Reminder | The schedule is still subject to 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. In case of emergency, please call our OPD at 0956-523-2574.
Please select the date you prefer*

MonthDayYear
Date
Please select the time you prefer*
In submitting this form I agree to my details being used for the purposes of my electronic health record. I understand my data will accessed by the necessary hospital staff and will not be distributed to third parties.*
I would like to receive the latest updates and promos from Binakayan Hospital and Medical Center*
Where did you see this online booking appointment?
Should be Empty:

BHMC Online Booking System

HEALTH DECLARATION FORM

Service Selection

Booking Appointment