Please complete this form with your personal information to register your assessment appointment at Clínica Ohmio. Verify that the information is correct before submitting it.
Preferred days and time for the assessment appointment
Personal information
Address
Emergency contact information
The medical assessment appointment fee is $99 USD
You can make the payment through any of the following methods:
Bre-B Bancolombia:
@oliveros7901
Bancolombia savings account:
25386748899
Account holder:
María Isabel Oliveros Ortiz
Once the payment has been made, please attach the proof of payment to confirm your appointment reservation.