PATIENT RESOURCES

PRE-CONSULTATION FORM

To confirm your appointment with Dr Andries van Niekerk at least 3 working days prior to consultation excluding weekends and public holidays, please complete the pre-consultation form and return with the following to info@orthomove.co.za:

  • Completed and signed pre-consultation form (all fields are compulsory)
  • Identification document
  • Medical aid/ Insurance card
  • Referral letter (if applicable)
  • Relevant diagnostic reports including radiology, pathology etc.

If the main member is the patient, please complete this form:

Pre-Consultation Form Main Member is the Patient

If the main member is NOT the patient, please complete this form:

Pre-Consultation Form Main Member is NOT the Patient

This practice does not submit fees for consultations and consumables to your medical aid. Consultation and consumable fees, including infiltrations, application of plaster cast and wound care are payable on the day of consultation. Payment methods accepted include cash, VISA and MasterCard.

Dr Andries van Niekerk is part of the Specialist Network at the following Medical Schemes, and by implication charges agreed tariffs for in-and out-of-hospital accounts: Bankmed (excluding Basic), Bestmed, Bonitas (excluding BonComprehensive, BonCap and BonStart), Discovery (excluding Essential), Fedhealth, Gems, Health Squared, Keyhealth, Momentum, Netcare, Polmed, Sasolmed (excluding out-of-hospital).