Start your appointment request here
We will ask you a series of questions that will guide your follow-up with an appointment coordinator
New Patient
Returning Patients
By clicking "Continue," you agree to allow us to use your responses and contact details to provide personalized health recommendations and updates for you. In addition, you also agree to Makati Life Medical Center's
Privacy Policy.
Continue
Are you the patient?
Yes, I'm the patient
No, I'm requesting for someone else
Next
Personal Information
First name
Last name
Middle Name
Birthdate
Phone
Email address
Next
Next, tell us your Primary Concern
We'll ask for a description of the medical concern that's prompting your request.
This should take about 2 minutes.
Next
Medical Conerns
Please include your diagnosis, if you have one. You do not have to provide a full medical history at this time.
What are you seeking care for?
Next
Now we'd like to ask about your Insurance Details
If you have insurance, please find your health insurance card, as you'll need it to complete these questions.
If you don't have Insurance, don't worry. We'll answer all of your questions on our call.
This should take about 5 minutes
Next
Do you have health insurance?
Yes, I have health insurance
No, I don't have health insurance
Next
What is your Yellow Card Number?
This is on the front of your Yellow card and is xx characters long.
Yellow card information number
Next
Insurance Information
HMO Provider
Select Provider
Yellow Card
HMO 2
HMO 3
HMO 4
HMO 5
HMO 6
HMO 7
Local Insurance
Select Insurance
Insurance 1
Insurance 2
Insurance 3
Insurance 4
Insurance 5
Insurance 6
Insurance 7
Next
Policy holder's Information
Policy holder's first name
Policy holder's last name
Policy holder's birthdate
Use same information from top
Same with my personal information
Next
Physicians Information
Physician's first name
Physician's last name
Physician's Clinic
Next
Let's Wrap Up
Here you'll complete your appointment request. After this, you can check your information of the requested appointment on your email.
Thank you!
Thank you for your trusting Makati Life Medical Center. One of our schedule coordinator will contact you within XX hours to confirm your appointment.
Thank you! Your submission has been received!
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