Welcome to Kidimed!

If your baby was not born at Pretoria East hospital, or has not seen one of the paediatricians in the rooms before, he/she is considered to be a new patient. New patients are required to complete the following form and accept the terms and conditions of the practice before confirmation of an appointment at the practice. The consultation prices are adjusted every year. Please phone 012-9989961 for the current price. (See ‘How do I pay?’). Also, please note that consultations not cancelled at least 2 hours ahead of time, could be charged for in full.

New Patients Information Form

Please complete everything…

MAIN MEMBER

Main Member birth date

PATIENT INFORMATION

Patient date of birth

Medical Aid

NEXT OF KIN

Please tick the appropriate box(es):

I understand the implication and agree that, where appropriate, the healthcare professional and practice may disclose my ICD-10 diagnosis code(s) under the conditions described above.

I understand the implications and request that the healthcare professional does not disclose the specifics of my diagnosis. The healthcare professional is to use ICD-10 code U98.0 (Patient refusing to disclose clinical information). In this case I assume full liability for the account in its entirety.

Terms & Conditions *