We will create your permanent Sanare patient record. You only need to do this once — future visits will use the same record.
As written on a valid ID.
Jr., Sr., III
What we should call you
For reminders and emergencies.
We use this to send your appointment and vaccine reminders
Emergency contact
Optional. Helpful if you plan to use PhilHealth benefits.
Helps us treat you safely.
These questions help us treat you safely. Leave anything blank if it does not apply to you.
Medicines, food or anything else. Separate with commas.
Include maintenance medicines. Separate with commas.
Separate with commas.
Optional. Separate with commas.
If you know it
Only if this applies to you
Almost done — one last step.
A short description is enough, for example: fever since yesterday, or dog bite on the leg.
Having trouble? Please approach the reception counter and our staff will register you.
