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We are now making it easier for doctors and dentists to be members and include their Web Profile in the RxPinoy Directory, for only PhP1500 per year. Simply fill in this form and read the Terms and Conditions below. You may want to print out a copy of these pages for your own records.


Only PhP1500 per year

Terms and Conditions

This agreement authorizes Infomediary Philippines, Inc. ("Infomed") to release your credentials and professional contact info through several channels: online on the RxPinoy web site; through standalone kiosks in hospitals through RxPinoy HIT; on air with various radio initiatives; in print form in the RxPinoy Health Directory; and using SMS and other wireless technologies.

EFFECTIVITY.
This Agreement will remain effective for one (1) year from date of your acceptance, and will be renewable upon mutual consent of both parties.

CANCELLATION
AND REMOVAL.
If you wish to have any or all of your contact information removed from the RxPinoy system at any time, you must contact Infomed through fax, email, or in writing. Infomed reserves the right to remove your full contact information from its database if you have knowingly falsified your credentials and other sensitive information.

ACCEPTANCE.
By clicking on the "SUBMIT" button below, you agree to be bound by the terms and conditions stated above. You also certify that all the contact information you provide on this online form is true and accurate.
 
A. Name and Specialty (Fields with * are required)

First Name*
Middle and/or...
...Maiden Name
Last Name*		 MD, DMD...*
Please combine my maiden & last names (e.g., Santos-Cruz)

Specialty (Medical or Dental)*
If not in drop-down list, kindly specify.
Subspecialties, other specialties, and/or areas of professional interest. You can use the box at right to describe your practice, or state particular aspects of your field on which you are focused, or which you would like to develop.
B. Clinics and Schedules


C1

 
Name of Clinic or Hospital
Room/Unit
Trunk & Local
Address City Direct Line

Clinic Schedule:
e.g. M,Th, 2-4:30 PM
By appointment or
First come first serve


C2
 Skip
this.

 
Name of Clinic or Hospital
Room/Unit
Trunk & Local
Address City Direct Line

Clinic Schedule:
e.g. M,Th, 2-4:30 PM
By appointment or
First come first serve


C3
 Skip
this.

 
Name of Clinic or Hospital
Room/Unit
Trunk & Local
Address City Direct Line

Clinic Schedule:
e.g. M,Th, 2-4:30 PM
By appointment or
First come first serve
To add more clinics, use the feedback field at bottom.
C. Additional Information (Optional)

Medical/Dental School
Location
Year Grad.
Postgraduate Training (and seminars attended)
Professional Accreditation (licensure information; dental/medical society
memberships, incl. year joined and status, e.g., PMA member since 1998)
Other significant professional details
(e.g., positions held, HMO affiliations, scientific work, etc.)
D. How can we contact you? (This data will not be publicly released.)

Mobile
Pager
Fax
Email
Feedback. Use this box to send us a short message concerning this form.
For all other messages, please use our Contact Us Form.
I accept the terms and conditions stated on this page (Required).
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This page last updated 04 January 2007.
Copyright © 2007 Infomediary Philippines, Inc.
All rights reserved. Reproduction in whole or in part in any form or medium
without the express written permission
of Infomediary Philippines, Inc., is prohibited.