Booking form

Bookings are valid for up to three days after the selected booking date.

A valid identification document must be presented on arrival, and any proof of medical aid or corporate referral, depending on the selected payment method.


General Details

Please select a Payment Type.
Please enter a Booking Date.

Guarantor/Guardian Details

Please enter a First name.
Please enter a Last name.
Please enter a Primary Identity #.
* Local citizens enter ID Number (for EHR linking).
* International travellers enter Passport Number.
Please enter a Telephone number.
Please enter an Email address.
Please enter an Address.
Please select a Province.
Please select a Country.
Zip code required.

Patient Details #

Please enter a First name.
Please enter a Last name.
Please enter a Primary Identity #.
* Local citizens enter ID Number (for EHR linking).
* International travellers enter Passport Number.
* Local citizens can enter Passport Number, if required for travel.
Please provide a Gender.
Please enter a Date of Birth.
Please enter an Address.
Please select a Province.
Please select a Country.
Zip code required.