COVID-19 RT-PCR Online Transaction

Last Name *

First Name *

Middle Name

Cellphone No.:*

E-mail address:*

Download CIF and Request Form

NOTE: Fill out one CIF and one Request Form for each individual and upload later.

8AM to 11AM and 1PM to 2PM Monday to Friday

NOTE: Preferred Date and Time will be coordinated with you by our Marketing Department for the schedule availability.

Bank Name METROBANK

Account No: 042-3-04254840-6

Account Name: University of Perpetual Help Dalta Medical Center

Amount to Pay (Per Person): 0.00

Choose Payment Type:

0/0MB

0/0MB

NOTE: Please include the reference number and date when you upload Proof/s of Payment.

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