APPEARANCE FORM

HEALTH PROMOTION SERVICES

NAME :
For Wellness Fair Participants:
Brand/Company Represented
Contact Number/s :
NOTE: Mobile number/s will be used for verification & clarification
purposes only by Payroll and will be kept confidential.
Please mark box with a check ( ).
ACTIVITY :  Wellness Lecture: Topic :
 Wellness Event/Activity :
 Physical Fitness Session :
 Others :

COMPANY :

SITE TIME IN TIME OUT CLIENT ACKNOWLEDGEMENT

(IF Official
DATE
APPLICAB SCHEDULE NAME DEPARTMENT SIGNATURE
LE)

For MediCard Use Only

VERIFIED BY: APPROVED BY:

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

DATE: _____________________ DATE: ______________________

INSTRUCTIONS FOR USE OF THIS FORM:
1. Print this form and accomplish all the needed information.
2. Bring the form to your assigned company event/activity. After the conduct of your activity (on the same day), have a company
representative (preferably the contact person) sign the “acknowledgement” portion.
3. Scan the form and email it to Onsite Clinic Management and Health Promotion Department at ocmhpd@medicardphils.com.
4. Use one (1) sheet per company. Multiple entries of events or activities can be written on the form.
5. Deadline for submission of this form will be 3 days from scheduled activity.

MEDICARD PHILIPPINES, INC.

Onsite Clinic Management and Health Promotion Department
4/F The World Center Bldg., Sen. Gil Puyat Ave.,Salcedo Village, Makati City
Tel. No. (02) 810-8212