Welcome to VRPMC's e-Konsulta+

PATIENT INFORMATION

Please provide your correct information. This will be used for your registration.
Name*

First NameMiddle NameLast Name
Gender*

FemaleMale
Civil Status*

SingleMarriedWidowedLegally Separated
Address*

House No., Street, Village

Street Address Line 2

BarangayCity / Province

Zip CodeCountry
Birthday*

MonthDayYear
Date
Viber Number*
Example: 0912-345-6789
Email*
example@example.com

PAYMENT DETAILS

Fill out the required fields.
Payment Type*

Self-Pay / CashHMO
Select HMO
Please select your HMO and be ready to upload your Valid ID and HMO Card.
Name of Card Holder
Company
HMO Card Number
Valid ID

Please upload a copy of the cardholder's Valid ID.
Cancelof
HMO Card

Please upload a copy of the cardholder's HMO card.
Cancelof

MEDICAL / CONSULTATION INFORMATION

Fill out the required fields.
Chief Complaint / Describe your medical concern for consultation.*
Consultation Category*

Initial ConsultationFollow-Up Consultation
Preferred Doctor*

YesNone, please choose for me.
Procedure / Diagnostic Test Results (if any)

Please upload a copy of the procedure / diagnostic test results.
Cancelof
Specialization*
General Pediatrics
General Surgery
Internal Medicine
IM Allergology & Immunology
IM Cardiology
IM Dermatology
IM Endocrinology
IM Gastroenterology
IM Geriatrics
IM Hematology
IM Infectious Disease
IM Nephrology
IM Neurology
IM Oncology
IM Psychiatry
IM Pulmonary & Sleep Medicine
IM Pulmonology
IM Rheumatology
Obstetrics and Gynecology
Pedia - Allergology & Immunology
Pedia - Ambulatory
Pedia - Infectious
Pedia - Nephrology
Pedia - Pulmonology
Physical Medicine and Rehabilitation
Surgery - ENT HNS
Surgery - Opthalmology
Surgery - Orthopedic
Surgery - Urology
Preferred Date and Time of Online Consultation

MonthDayYear
Date
Hour MinutesAM/PM Option

WAIT FOR CONFIRMATION!

Our Digital Concierge Officer will be in touch to confirm your preferred telemedicine appointment. Please provide the name of the patient, preferred date and time of consultation and name of the doctor/specialization. Once the appointment has been confirmed, payment instructions will be sent to your designated Viber number. Thank you for choosing our services!
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PATIENT INFORMATION