Online pre-admission

Online pre admission

Please complete this form.

Please complete the questionnaire for patients booked for general anesthesia and send it back to us. Click here

  • Doctor's Information

  • Date Format: MM slash DD slash YYYY
  • Please complete - Full details of patient

  • Date Format: MM slash DD slash YYYY
  • 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

  • Date Format: MM slash DD slash YYYY

Please complete this form.

Please complete the questionnaire for patients booked for general anesthesia and send it back to us. Click here

  • Doctor's Information

  • Date Format: MM slash DD slash YYYY
  • Please complete - Full details of patient

  • Date Format: MM slash DD slash YYYY
  • 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

  • Date Format: MM slash DD slash YYYY

Please complete the questionnaire for patients booked for general anesthesia and send it back to us. Click here