To request an appointment with Dr Andries van Niekerk, please complete the patient’s information below.
Date of Birth
Medical Aid or Insurance
Practice Location —Please choose an option—Cintocare PretoriaUnitas CenturionSecunda
With your signature hereto, you consent to the processing of your personal information and further consent to the Practice sending you emails:
DR ANDRIES VAN NIEKERK (“the Practice”) requires your personal information for the following purpose:
to capture the personal information on the Practice’s server;
to aid the Practice in account settlements and to provide information to medical aids, if applicable; and
to enable a holistic treatment approach involving a multidisciplinary team.
The Practice will not be in a position to provide you with their services if you do not consent to the processing of your personal information.
The Practice stores all personal information obtained from you for a period of 5 (five) years.
You have the following rights in respect of your personal information:
to object to the processing of your personal information obtained by the Practice;
to withdraw your consent (where granted) to the processing of your personal information by the Practice provided that the lawfulness of the processing and the actions required for the conclusion or performance of a contract will not be affected;
to request access to your personal information processed by the Practice;
to request that your personal information be corrected or deleted/destroyed; and
to lodge any complaints with regard to your personal information with the Information Regulator of South Africa.
The registered address of the Practice is: Suite 2, Cintocare Hospital Level 4, 175 Frikkie De Beer St, Menlyn, Pretoria, 0181.