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Patient Details Forms
Medical Aid Details
Please provide Main Members Details:
- All fees must be settled on the day of the appointment.
- Any additional procedures will be at an extra cost.
- Our fees are alined with the medical aid rate that we are contracted in with.
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We kindly request that appointments must be canceled at least 6 hours before the time. By failing to do this, a “no show” for an appointment could be considered for billing purposes
- I, do hereby agree to pay all legal fees and collection costs in the event of delayed payment of my account.