Pasient Besonderhede

Posted by on Sep 22, 2012 in Patient Forms |

Click here to download the form if you do not wish to complete it online. Let Wel: U is persoonlik verantwoordelik vir die rekening. Privaat/uitgekontrakteerde fooie word gehef. Konsultasies is betaalbaar na afloop van die konsultasie. * Verpligte Inligting Van* Naam* Voorletters Titel ID Nommer* Geboorte Datum Tel (H) Tel (W) Sel nommer Faks nommer Verwysend Dokter Persoon verantwoordelik vir die rekening Van* Naam Voorletters Titel ID nommer*...

Read More

Patient Details

Posted by on Sep 22, 2012 in Patient Forms |

Click here to download the form if you do not wish to complete it online. Please note: You are personally responsible for the account. Private fees are charged. Consultation fees are payable after the consultation. * Required Field First Name:* Last Name:* Email:* Initials Title ID number* Birth Date Tel (H) Tel (W) Cell Referring Doctor Person responsible for account Last Name* First Name Initials Title ID number* Birth Date Postal Address...

Read More