Patient request

Request a Consultation

Start with a short request. You will create a simple patient account so you can return later to check its status.

Patient Login Already have an account? Check requests and continue later. Our Doctors Review doctor profiles first. Your draft will stay on this device.

For non-emergency clinic requests only.
Use local emergency services for urgent or life-threatening concerns.

Submit your request Fill in a short form - takes about 3 minutes. Pick a preferred doctor and telehealth type.

Clinic reviews & confirms The clinic reviews your request and sends you a confirmation with schedule details.

Attend your consult Join by video call or phone. Your records are kept privately and securely.

Request type Last name First name Middle name

Date of birth

Age

Sex / Gender Address, including barangay Email address Mobile number Create password Confirm password Preferred doctor Preferred date (optional) Preferred time (optional)

Picking a date and time helps the clinic schedule you faster, but isn't required — leave blank and the clinic will reach out to arrange a time.

Reason for consult

Drug Dependency Examination details

Civil Status Nationality Birth Order Educational Attainment Last School Attended Year Last Attended Occupation Religion Spouse / Partner Father / Parent or Guardian Father / Parent Age Mother / Parent or Guardian Mother / Parent Age Upload Pictures / Results

Selected file names are recorded with your request. The clinic may ask you to send originals through its preferred channel.

Available Telehealth Options

Video call (via Google Meet) Phone call

Note: Your Telehealth consultation selection is not guaranteed. Your symptoms and Doctor communication preference may require a Telehealth type other than your initial selection.

General consultation requests only need the details above. The clinic may ask for more information later.

Your request has been received. Please complete the short intake form below — it helps the doctor prepare before your consultation. You must also read and accept the telemedicine consent before proceeding.

Chief complaint

What is your primary reason for this consultation? *

Medical background (optional)

Current medications Known allergies Relevant medical history

Emergency contact (optional)

Contact name Relationship Contact phone number

Telemedicine consent * I have read the Telemedicine Consent above and I agree to its terms. (open the consent above first)

Request a Consultation

Request received

What kind of consultation do you need?

Before You Request a Consultation