Questions & Feedbacks

Room Reservations

ROOM RESERVATION FORM

Reserve a room in 3 easy steps:

Fill in the reservation form below with the patient’s pertinent information.
Our Admitting Associate will contact you via voice call or SMS for verification.
Room of choice will be ready on the day of your admission.

All rooms are subject to availability. Room reservations shall be done at least 24 hours before admission. Reserved rooms shall be cancelled if patient failed to show 2 hours after the expected time of arrival.

ROOM RESERVATION FORM

Patient’s First Name:

Patient’s Middle Name:

Patient’s Last Name:

Suffix:

Birthdate:

Age:

Gender:

Religion:

Address:

Reason for Admission:

Doctor:

Insurance/HMO:

Room of Choice:

Expected Date of Admission:

Expected Time of Admission:

Contact Number (Landline):

Contact Number (Mobile):

Email Address: