Dr. Pau David - Developmental Assessment Registration Form
Hello!

This is the registration form for scheduling a developmental assessment with Dr. Paula David (Developmental and Behavioral Pediatrician).

Once accomplished, you will be added to the waitlist for scheduling. Once a schedule is available, you will receive a text message for confirmation of your schedule. An email with intake forms and videos will be sent to you to prepare prior to the consult.

CLINIC SCHEDULE (Strictly by Appointment):

LOCATIONS:
     TARLAC:
           D-212 JMTalon Diagnostics Inc, Rizal cor Panganiban St, Tarlac City

     QUEZON CITY: 
          Room 202, UERM Hospital, Aurora Boulevard, QC
     
FEES:
     New Patients (Initial Evaluation): 4,500php
     Old Patients (Repeat Evaluation): P4,000php
     Old Patients (Follow-Up Consult): 3,500php

Mode of Payment: Cash/ Online Banking (Unionbank or Gcash)

Thank you for your cooperation! We can't wait to meet with you and your child soon!

If you have any questions, you may email us at ppdavidmd@gmail.com or text us at 0909-906-6959.

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Email *
Child's Full Name (Last Name, First Name)

 *
Child's Nickname *
Child's Birthday *
MM
/
DD
/
YYYY
Child's Age *
Contact/ Mobile Number (please make sure this is your ACTIVE number because we will be communicating with you here) *
Email Address *
Present Home Address *
Mother's Name

 *
Mother's Occupation

 *
Father's Name

 *
Father's Occupation

 *
What concern/s do you have with your child? *
Required
Has your child been seen by a Developmental Pediatrician before? *
Any medical or developmental diagnosis?
If yes, who was your child's Developmental Pediatrician?
Where would you prefer to have your child assessed? (check all that apply) *
Required
Who referred you to us? *
A copy of your responses will be emailed to the address you provided.
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