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Guidelines and Protocols for requesting appointment dental procedure(s)

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

 

STRICTLY by APPOINTMENT ONLY.

 

You May text your Inquiries to :

 

0917 174 5454 (Multinational Village, Paranaque   and BF Las Pinas Branches)

 

0917 570 6123 SOFT OPENING ( Pavia ,Iloilo  Branch)

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 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 

—Management

 

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

    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 youOu

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