Online pre-admission

Online pre admission

Please complete this form.

  • Doctor's Information

  • Please complete - Full details of patient

  • Person responsible for account

  • Employer's detail (Person responsible for account)

  • Contact person in case of emergency/next of kin (not someone who lives with you)

  • Person responsible for account

Please complete this form.

  • Doctor's Information

  • Please complete - Full details of patient

  • Details - Main member of Medical Aid

  • Employer's detail (Main member/Person responsible for account)

  • Contact person in case of emergency/next of kin (not someone who lives with you)

  • Main member / Person responsible for account