Refer a patient

Would you like to refer your patient to a specialist area in our clinic? Then please complete the registration form below.

Emergency consultation
In the emergency consultation, outpatients can be assessed within 24 hours, in order to initiate urgent assessments and treatment. We kindly request that you notify us of any emergency patients by phoning 044 385 7445.

Diagnosis
Treatment is due to
Patient details
Referring doctor
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