MIHMCI RT-PCR Appointment

Online Registration Form

Advisory! Please download the CIF Form and Waiver Form after registration, please fill up forms and show it to our personel at MIHMCI for faster transaction.

Please write legibly and make sure the data provided is true and correct. These data are sent to DOH as part of mandatory reporting of covid laboratories.

Personal Information

First Name:
Middle Name:
Last Name:
Suffix:
Birthdate:
Gender:
Civil Status:
Occupation:
Date of RT-PCR Test:
E-Mail:
House No./Lot/Bldg.:
Street/Brgy:
Municipality/City:
Province:
Region:
Home Phone:
Contact #:
Nationality:








Name of Facility: Address of Facility:
 

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