Client Registration

1. Please make sure that your internet connection is fast and stable. Preferably use a wifi connection or a good data connection (4G+ at least).

2. Once connected to the online form, DO NOT REFRESH or RELOAD the page to prevent disconnection from the server.

3. Upon successful submission of your information, a QR code will be generated. Please save a copy (screenshot or print) of this QR code and other information included in the code and show it to Window 1 or Reception.

4. GentriMed is NOT RESPONSIBLE for inaccurate, false, incomplete, or missing information provided by the client/patient. Please make sure that all information are correctly provided. Check for misspelled information (name, address, etc.).

Fields with * in their labels are REQUIRED.

SELECT THE TYPE OF TEST REQUESTED*

Personal Information


Check for misspelled information. DOUBLE-CHECK the entry. Provide complete and accurate information. GentriMed is NOT RESPONSIBLE for inaccurate, incomplete, or wrong information provided by the client/patient.

Contact Information

Current Address

Permanent Address

If not same as current address, please fill out these fields:

Employment Information

Special Population

Are you a health worker?* (Fill out the other fields if yes)

Are you a returning OFW?* (Fill out the other fields if yes)

Are you a foreign national traveller?* (Fill out the other fields if yes)

Are you an LSI/APOR/Local Traveler?* (Fill out the other fields if yes)

Do you live in closed settings?* (Fill out the other fields if yes)

Consultation Information

Have you had previous COVID-19 related consultation?*
(Fill out the other fields if yes)

Disposition (REQUIRED)

Health Status (REQUIRED)

Case Classification (REQUIRED)

Vaccination Information

Are you vaccinated against SARS-CoV-2?* (Fill out the other fields if yes)

Clinical Information

Are you pregnant*?

Laboratory Information

Have you tested positive using RT-PCR before? (Fill out the other fields if yes)

Contact Tracing: Exposure and Travel History

Have you been exposed to a known COVID-19 case 14 days before the onset of signs and symptoms?

Have you been in a place with a known COVID-19 transmission 14 days before the onset of signs and symptoms?

Additional Information

If you will use the testing report for travel, please indicate the airline/sea vessel (example: Philippine Airlines) and the flight/vessel no. Indicate also the "Travel Destination".

Ang mga alinsunod na alintuntunin ay ang mga sumusunod:

1. Sumasang-ayon ako na malayang makuha ng Gentri Medical Center and Hospital Inc. ang mga "Test Samples" para sa Reverse Transcription Polymerase or RT-PCR para sa COVID-19 sa pamamagitan ng nasophyngeal swab and/or oropharyngeal swab


2. Malinaw na naipaliwanag sa akin ng pamunuan ng ospital ang tuntunin at proseso ng pagsusuri sa aking sample na gagawin sa Gentrimed Molecular Laboratory ng walang pag-alinlangan at sapilitan.


3. Sumasang-ayon ako na walang pananagutan ang pamunuan ng ospital sa pagkaka-antala ng paglabas ng resulta ng Reverse Transcription Polymerase or RT-PCR para sa COVID-19.