Online LOA Request – Carmona Hospital and Medical Center

LOA Request

PATIENT INFORMATION

LOA approval for doctor’s consultation shall be done manually onsite.
Same day online LOA Approval will not be accepted.

HMO OPERATING HOURS:
Monday – Friday / 6:00 AM – 7:30 PM
Saturday / 6:00 AM – 5:30 PM

Full Name *

Date of Birth

Email *

Phone Number *

HMO Provider *

Type of LOA Request *

HMO Card Number *

Availment Date *

Employer (Company Name) *

Illness/Health Complain *

Referral Request *

Click or drag files to this area to upload. You can upload up to 3 files.

Valid ID

Click or drag a file to this area to upload.

Health Card ID

Click or drag a file to this area to upload.

LOA Request

PATIENT INFORMATION

Get in Touch

OUR SERVICES

CONTACT US

Governor's Drive, Cor Purification Street, Brgy. Mabuhay, Carmona, Cavite

mktg@chmci.net

Cavite (046) 419-8110

Laguna (049) 559-8180

Manila (02) 657-1780

We are HIRING!