LOA Request

LOA Request

Our online HMO Concierge provides personalized and technical assistance to address any possible HMO member difficulty. We provide online assistance in scheduling appointments and LOA coordination with your providers for onsite outpatient utilization of our services.

Online LOA Requests Form

Diagnostic Tests
Others (Please specify)
For procedures with MD request
Please attach document
Attach Valid ID/HMO Card (required)
Please attach a scanned copy of your valid ID
Data Privacy Context

In compliance with the Data Privacy Act of 2012, The Medical City ensures that the information you provide will be kept strictly confidential and will only be processed, disclosed or shared upon your consent, or by law.

  I Agree