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PATIENT INFORMATION

    PATIENT DETAILS








    MAIN MEMBER’S DETAILS/BESONDERHEDE VAN HOOFLID:






    THE TARRIF CHARGED AS THIS PRACTICE AS ABOVE MEDICAL AID SCHEME RATES

    The account remains the responsibility of the patient. Please settle your account immediately, and submit your claim(s) to your Medical Aid for refund.

    Accounts outstanding for longer than 120 days will be handed over for collection. Costs involved will be paid by the patient.

    IT IS THE PATIENT’S RESPONSIBILITY TO ARRANGE AUTHORISATIONS WITH THEIR MEDICAL AID