Appointment Request

Book a visit

Submit an appointment request and our team will confirm your schedule.

Patient

Visit

Preferences

Patient info

Who are we booking for?

Step 1

Fields marked with * are required.

Existing patient?

Enter your Patient ID to auto-fill your details. Forgot it? Use mobile or email.

Optional

Patient ID

Mobile number

+63

First name *

Last name *

Mobile number *

+63

Enter 10 digits after +63.

Sex *

Birthdate *

Required to auto-calculate age.

Age

Civil status *

Address *

Occupation (optional)

Emergency contact name *

Emergency contact number *

+63

Enter 10 digits after +63.

Email (optional)

Visit details

Share the timing and reason.

Step 2

Preferred date *

Preferred time *

Reason for visit *

Preferences

Optional doctor and specialty.

Step 3

Choose specialty (optional)

Showing specialties available on the selected date.

Choose doctor (optional)

By submitting, you agree to the clinic booking policy.

What happens next?

Your request is reviewed and confirmed based on availability.

Our front desk reviews your request.

We confirm your time and send reminders.

Need help?

Our team can help you choose a schedule, doctor, or service.

+63 917 456 7788 hello@nexufy.demo