OTHERS

1. Fill out the request form : RECORDS REQUEST FORM 

2. Send the filled out form to: sisongimelodental@gmail.com

   • SUBJECT: RECORDS REQUEST FORM 

FULL NAME OF PATIENT:

BRANCH:

2. • If you are requesting records for a minor or a deceased person, kindly send in  your proof of legar guardianship or authority 

     • Birth Certificate - this is sufficient for biological parents 

     • Notarized affidavit of Guardianship 

     • Court Order

     • Death Certificate

     • Affidavit of Self-Adjucation

     • Special power of attorney

3. Once the request has been recieved we shall be sending you an acknowledgement email and assessment fees.

4. Processing of request will take 5 to 7 working days depending on the workload of our staff

5. We shall be informing you once the records can be picked up.

Processing fees:

1. Patient Chart records : P100 (first 4 pages), P20 per additinal page

2. Dental Xray reprinting: P100 per Xray 

3. Ortho Photos reprinting: P100 per ortho photo

4. Soft copy in records in USB: P300