Offline

Doctor/Patient

Practitioner
Patient

We aim to tailor the experience according to the needs of the website user. Please don't select an option that will negatively influence your experience,

Please select field of interest

This information allows us to tailor your landing page experience when returning. In order to generate a username and password for you on our system we will require the additional information below.

Name *

First

Last

To set up your online PACS account upon referral.

Name *

First

Last

To tailor the site to your interests.

HPCSA professional registration number

BHF/PCNS practice number

Cell number

This is useful if we need to uregently discuss a patient with you.

Personal/Direct Email

Email

Confirm Email

Required to set-up you account and send reports. Please only us an email account to which only you have access, according to the POPI act.

Personal/Direct Email

Email

Confirm Email

Required to set-up you account and send reports. Please only us an email account to which only you have access, according to the POPI act.