MyReady application

Apply for a Medocare MyReady plan. Medocare reviews your application, confirms the annual fee and contacts you within one working day.

Medo

This is the MyReady application form, online. Fill in every part and I will check it before you send it.

Please complete all information requested. Incomplete details will not be processed.

Plan

Standard MyReadySilverStandard MyReadyGoldMyReady PlusSilverMyReady PlusGold

I. Applicant information

Last name

First name

Middle name

Suffix (Sr., Jr., I)

Permanent address

Number

Bldg.

Street

Barangay

City / Province

ZIP code

Email address

Mobile number

Landline / Residence

Date of birth

Age

Place of birth

Gender

MaleFemale

Civil status

SingleMarriedWidow/erSeparated

II. Program information

A. Type of membership

IndividualGroup

B. Membership fee

Annual mode of payment only. Medocare confirms the fee for your plan before you pay.

Health Advisor (if someone is helping you)

Their name or code number.

Anything you'd like us to know (optional)

Declaration and signature

I declare that the statements and all answers contained herein are full, complete, and true. And if found otherwise, I agree that this healthcare plan may be ineffective. I hereby authorize any person, or entity having a record or knowledge of my health to give to Medocare all information relative to any hospitalization, medical treatment, or consultation that I may have undergone.

Signed in (city), Philippines

Signature of the applicant

Type your full name. It is dated when you send this form.

I agree to Medocare contacting me about membership using these details.[Consent wording from Medocare’s Data Protection Officer goes here.]