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In order to maintain a Covid-Free Clinic, reduce face to face exposure at our clinics and help keep our patients, staff and community healthy,  we shall follow strict Guidelines and Protocols recommended by the Philippine Dental Association.

As of this time, we can not accommodate Walk-In Patients. 

STRICTLY by APPOINTMENT ONLY.

You May text your Inquiries to :

0917 570 6123  (BF Las PInas and Bacoor Branches by Dr. Aire Pahila)

 

0917 174 5454 (Multinational Village, Paranaque  Branch by Dr. Jong Abaring)

 

0917 570 6123 SOFT OPENING ( PAVIA , ILOILO Branch by Dr. Ahlea Llenos-Sampil and Dr Aire Pahila)

 

0928 163 4516  (MyDentalZone For Kids by Dr. Nica Bernabe-Antonio)

 

We will conduct a Pre-Evaluation/Assessment of every patient prior confirmation of Appointment to determine if we can proceed with your desired dental procedure. 

PLEASE Fill out the Covid Pre-Screening Form below. Same form will be filled out by the companion if the patient needs to bring one (only for minors, seniors and PWDs)

 

Dental Clinic Protocols and Fees may be discussed prior confirmation of appointment.

Stay Safe 

—Dr. Aire Pahila & Dr. Jong Abaring

 

For your reference, please take time to read  Tips: Instructions to Patients Prior Appointment

BOOKING REQUEST FORM

Note : If Your form has been successfully submitted. We will inform you as soon as assessment is done. Typically within 1-3 days. Thank you.

    Preferred MyDentalZone Clinic



    Gender Identification*





    address

    Nationality

    Occupation

    Are You the Patient

    Nature of Dental Complaint or Concern

    RISK FACTOR Questionnaire.
    Have you ever Visited any Country(ies) a month(30 days) prior to this planned visit to our healthcare facility?

    If Yes, specify Country(ies) or City(ies) from most recent
    Name of Country/city , Date Visited , Date Departed

    History of Covid19 Exposure
    Please Check all that Applies, Have you had close contact with:
    Persons Under Investigation (PUI)

    Persons Under Monitoring(PUM)

    If YES, How long each time? Choose Maximum time exposure?

    Face to Face exposure?:

    Face to Face exposure? with Personal Protective Equipment (PPE)?:

    SYMPTOMS
    Have you ever experienced any respiratory symptoms (Sore Throat, Runny Nose, Cough, shortness of breath) Prior to your visit to our healthcare Facility:
    FEVER:

    Please Indicate if you are experiencing the following, Symptoms:
    SORE THROAT:

    COUGH:

    RUNNY NOSE:

    SHORTNESS OF BREATH:

    OTHER SYMPTOMS,
    CHILLS:

    NAUSEA:

    DIARRHEA:

    HEADACHES:

    JOINT ACHES:

    MUSCLE ACHES :

    GENERAL MALAISE:

    LOSS OF APPETITE:

    I understand that this is a Pre-Screening Procedure prior my Dental Appointment or Dental Procedure. I understand that upon assessment by the Dentist, I may be given a confirmed appointment or a referral to other Specialist(s) or Healthcare Faciliity . I have answered everything to the best of my knowledge.

    Name of Parent/Guardian if Patient is a minor


    Note: If Your form has been successfully submitted. We will inform you as soon as assessment is done. Typically within 1-3 days. Thank you.

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