CDB Student Profile Form

Version 2019

Main Office: H. Abellana Street, Canduman, Mandaue City, Cebu 6014

Branch: Marren Building 3rd Floor 1157 Quezon Avenue, Brgy. Sta. Cruz, Quezon City, Manila

The Premiere and Most Respected Medical Review Country in the Country
“Our Culture of Excellence Speaks For Itself”

2 x 2 Recent Photo

Please Fill up Properly all the information required

General Information

Last Name First Name Middle Name Age Sex Marital

Status

Birthdate Birthplace Home Address

Contact Number E-mail Address Batch Enrolled In.

Please Check

[ ] September
[ ] March

Year 20__

Father’s Name Father’s Occupation Mother’s Name Mother’s Occupation

Person to contact in case of Emergency

Who Recommended you to Enroll In CDB Review?

 29TH GLOBAL EXCELLENCE FOR BUSINESS & ACHIEVERS 2016 AWARDEE MOST BEST MEDICAL REVIEW
2 CENTER 36TH CONSUMERS CHOICE 2016 AWARDEE BEST MEDICAL REVIEW CENTER

How did you Hear About CDB Review Center? Please Check. You may check more than one option.

[ ] Friends/Relatives/PGIs/Residents/Consultants
[ ] Website/Facebook/Online Posts/Blogs
[ ] Newspapers
[ ] Brochures
[ ] Old CDB Students

Academic Background

Pre Medical Course/Degree School Did You Graduate with Honors/ Special Citations?
Please Specify

Doctor of Medicine (MD) Date of Graduation Did You Graduate with Honors/ Special Citations?
School Please Specify

Indicate Class Rank upon Hospital of Postgraduate

Graduation from Medicine Internship (PGI)

Professional Licensure Have You Taken The What Review Center (s) Have you Previously
examinations Taken and Physician Licensure Enrolled in the past?
PASSED Examination (PLE)
before?

[ ] No, I am a First Time [ ] School Sponsored Review Program (E.g. UST,

taker FEU, OLFU, DMSF, MHAM)
[ ] Yes
[ ] Cracking D’ Boards (CDB)

If Yes, Please indicate how [ ] Topnotch Board Preparation

many times
[ ] MACAR Review

[ ] Once [ ] Twice [ ] Primus Review

[ ] Post Refresher Course
[ ] APMC/ UPEC Review

What is your Strongest What is your Weakest What subject do you fear the most?
Subject(s)? Subject(s)?

Do you have any medical conditions?

Note: ALL Information will be confidential. ONLY the program Director Dr. Vatanagul will have access to this
data.
( ) HPN ( ) Diabetes ( ) Asthma ( ) Cardiac Diseases (e.g. VHD, CHF, MVP)

( ) Neurologic/Psychiatric Conditions (e.g. Anxiety, Depression, OCD, ADHD, Dyslexia, Bipolar/Psychosis)

( ) Person with physical disability (Pls. specifiy)
CDB Student Profile Form
Version 2019

Terms and Conditions

All details provided in this Form must be true.

Student/Reviewee must pay the Review Fee in the amount of
P________________________________ thru CDB’s authorized representative or Bank account.
Those paying on installment basis are required to pay at least 50% of the Review Fee during
the first installment payment.
The Review Fee must be paid in full on two weeks before the start of the review class,
otherwise the delinquent student/reviewee will not be entitled to receive hand-outs or join certain
review activities. Once payment is made and duly received by CDB representative, Review
application shall be considered confirmed.
Student must then fill up and sign the Review Form which will be given either personally or thru
email in order to complete the enrolment process. Review Form must be submitted back to CDB
representative, either personally or thru email.

Once review application is confirmed, Review Fee shall be NON-REFUNDABLE and NON-
TRANSFERRABLE, regardless of the student’s/reviewee’s reason for cancelling his/her review.
Review Fee shall also be forfeited in favor of Cracking D’ Boards Study and Review Center, Inc. if
the student/reviewee decides to discontinue after the review has started.
Student/Reviewee has read and understood the foregoing terms and conditions.

Signed this ___ th day of ___________, 20__ in ________________, Philippines.

_______________________________________________
Signature of Student/Reviewee Over Printed Name

CDB Representative

NOTE: Please email back completed and Signed Review Form or submit in person at our
designated offices. Attach a recent photo in form.