Register

Each patient needs to create their own profile. If you are registering on behalf of your child, spouse, or parent, please ensure that their details are input below.

Personal Information

Username: *

Password: *

Confirm Password: *

Name: *

Last Name: *

ID/Passport: *

ID Passport

ID: *

Date of Birth: *

Gender: *

Email Address: *

Cell Number: *

Address: *

Province: *

City: *

Suburb: *

Medical Aid Details

Employer Bio:

Industry:

Medical Aid Provider:

Medical Aid Plan:

Medical Aid Option:

Medical Aid Number:

Dependent Number:

Account Recovery Option (Must supply one)

Recovery Cell:

Recovery Email:

I accept the Terms and Conditions contained here-in