Patient Registration | Globalife Medical Laboratory & Polyclinic

Before you register

Use accurate details (same as your valid ID when possible). Our clinic uses this for appointments, lab results, and emergency contact.

Active mobile number for SMS verification and clinic reminders
Email is optional, but helpful for password reset and email notices
A username you will remember — you need it every time you log in
Emergency contact (recommended for urgent clinic situations)

* Required fields

Personal Information

Full Name

Maximum of 40 characters. 0/40

Sex / Gender

Date of Birth (DOB)

Future dates are not allowed.

Age

Civil Status (Optional)

Contact Information

Mobile Number

For SMS or call about your appointment and lab updates.

Email Address (Optional)

Optional. If left blank, your verification code will be sent by SMS.

Where should we send your verification code?

Choose one. If you do not add an email, SMS will be used automatically.

Email Send the code to the email address above, if provided. SMS Text the code to the mobile number above.

Address

Barangay

City

Account Information

Username

Save this — you will enter it every time you log in to the patient portal.

Password

Password Requirements:

At least 8 characters

One uppercase letter (A-Z)

One lowercase letter (a-z)

One number (0-9)

One special character (!@#$%^&*)

Confirm Password

Emergency Contact (Recommended for clinic safety)

Helps our staff reach a family member if you need urgent assistance during a visit.

Name

Relationship

Contact Number

I agree that Globalife Medical Laboratory & Polyclinic may collect and use my information for patient records, appointments, laboratory services, and contact related to my care. I confirm the details above are accurate.

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