Declaration and Data Privacy Consent
By submitting, I am agreeing that the information I have given is true, correct, and complete. I understand that failure to answer any question or giving false answer can be penalized in accordance with law. I voluntarily and freely consent to the collection and sharing of the above personal information in relation to RCOC COVID-19 internal protocols and for the purpose of affecting control of the COVID-19 infection as required by R.A. 11469, Bayanihan to Heal as One Act. I consent to the use of the above personal information to book appointments on my behalf.