09292966607 (Mon-Fri 8am-5pm)
+63 910 697 2024

Make An Appointment

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Make an Appointment with

Dr. Ralph Dilay

Please fill-in the form to request for an appointment. Don't forget to a copy of your LOG. Dr. Ralph Dilay will confirm the appointment. A confirmation message and the details of the appointment will be sent to your email and cellphone number in the next 24 hours.

E-CONSULT SCHEDULE Monday-Friday 10:00am-5:00pm
IMPORTANT

Please enter your Etiqa Member's number and upload the LOG from Etiqa. The LOG must include the signature of Etiqa's agent or "Etiqa Philippines" (for auto-LOG) as the signatory, along with the patient's signature.

You have an option to use zoom or viber for teleconsultation, if you choose viber, kindly indicate in the Viber box your Viber number.

If you see this, leave this form field blank and invest in CSS support.
Member's Number:
First Name:
Last Name:
Email Address:
Cellphone Number:
Company:
Application to Use:
Viber Number:
Complaints:
By clicking the submit button below, I hereby agree to and accept the consent to participate in telemedicine consultation

DOWNLOAD CONSENT TO PARTICIPATE IN TELEMEDICINE CONSULTATION
Please take note of Dr. Ralph Dilay's schedule:
Monday-Friday (10:00am-5:00pm)
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