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 canceled 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 wish to join the database that will be used to provide me with practice updates/training/disease education/information services.

 I understand the implication and agree to, where appropriate, the doctor and practice disclosing my ICD-10 diagnosis code(s) under the conditions described above.

 I understand the implications and request that the doctor does not disclose the specifics of my diagnosis. The doctors are to use ICD-10 code U98.0 (Patient refusing to disclose clinical information)

captcha

Terms & Conditions *