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Online HMO Approval

Streamline Your Health Coverage

Complete the form below to process your HMO requests at least 2 days before your scheduled visit. You will need to upload a valid ID, HMO card, and a test request issued by an HMO-accredited doctor with a corresponding diagnosis. Please note that any unmatched details may cause delays in approval, and we may contact you for verification if necessary. You can check our list of accredited HMOs here.

Ensure that this form is submitted at least 2 days before your appointment. Approved requests will only be valid for 2 days from the scheduled date.

You will receive a confirmation email once your request has been successfully submitted. A follow-up confirmation email or phone call from our staff will be sent once your booking and approval are finalized.

Online HMO Approval Form

Make Appointment

Client Information

Upload Valid ID (Front & Back)

HMO Information

Upload HMO ID

Doctor and Diagnosis Information

Notice: To process the request, the HMO needs the doctor's initial diagnosis (e.g., patient condition, rule out, or considerations).

Upload Doctor's Request (5 Files Max)

I hereby certify that the information provided in this form is complete, true, and correct to the best of my knowledge. I also acknowledge that I have read and understood the Shalom Medical Clinic Privacy Policy and agree to its terms. I give my consent to Shalom Medical Clinic to collect, use, and process my personal information. I understand that this consent is required for the lawful processing of my personal data and does not waive any of my rights under the Data Privacy Act of 2012 and other applicable laws.