Forms

Please click on the links below to download the applicable forms

INTERNATIONAL PATIENTS:

Credit card payment form for international patients (payment in USD):  USD Credit Card Transaction Authorisation

*Please note that the transaction will be processed in ZAR at the prevailing exchange rate on date of transaction.  Your bank might levy additional fees in this regard.

UK PATIENTS:

Credit card payment form for UK patients (payment in GBP): Credit Card GBP Transaction Authorisation UK

*Please note that the transaction will be processed in ZAR at the prevailing exchange rate on date of transaction.  Your bank might levy additional fees in this regard.

LOCAL PATIENTS:

Credit card payment form for local patients (payment in ZAR)  Credit Card ZAR Transaction Authorisation

**Note: South African Credit card payments are subject to a 3% surcharge**