Online LOA Request

LOAs are advised to be filed at least 3 days prior to your availment date. Please allow us at least 24 hours to process your request once submitted.

DISCLAIMER: Please be reminded that requests made beyond *office hours will be processed on the next business day.

*QUEZON CITY: 7:00AM - 5:00PM (Monday to Saturday except Holidays)

*GLOBAL CITY: 7:00AM - 7:00PM (Monday to Saturday except Holidays)

Last Name

First Name

Middle Name

Date of Birth

Cell Phone No.:

HMO Provider

Local Insurance

Company/Employer

Type of Request

In-Person Consultation

Teleconsultation

Outpatient (Laboratory, Diagnostic, Surgery)

OP - Drivethru

Admission

Preferred Hospital

HMO Card Number / Local Insurance Number

Date of Consultation / Date of Laboratory Procedure

Name of Preferred / Existing Doctor(if any)

Chief Complaint

Valid ID

Please attach a scanned copy of your valid ID.

HMO ID

Please attach a scanned copy of your HMO ID.

By clicking "Submit", you are allowing St. Luke's Medical Center to store your personal information and keep in touch with you if necessary.