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First Division
Alabang Branch
Las Pinas Branch
Second Division
Patient with Health Card
Patient without health card
Complete Name
HMO Provider
Maxicare
Intellicare
Dental Network
Valucare
Medicard
Philcare (If Philcare, need additional form space for PC Number)
Account Number
Birthday
Company
Principal Name
Principal Birthday
Contact Number
Email
Preferred Day
Weekends
Weekdays
Preferred Time
AM
PM
Notes
Principal Name
Contact Number
Email
Preferred Day
Weekends
Weekdays
Preferred Time
AM
PM
Notes
Kindly take note that there is an infection control fee amounting to 500 pesos PER patient per visit to our Marcos Alvarez Branch and Parkway Filinvest Branch . This is aimed at safeguarding not only our patients but also our dental staff. As dental professionals, we are highly exposed to aerosols and other potential diseases, not just Covid. By employing stringent infection control measures and providing appropriate PPE to patients, we can mitigate the risks and enhance the safety of everyone in our clinic. It is important to note that this fee, which includes PPE for the patient, will not be covered by your health card provider. Rest assured that we are committed to providing a safe environment for both our patients and dental staff. Please wear your facemask when entering our clinic. Thank you.
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