Please select an account type from the following: *

Self Payment (Private accounts are to be settled on day of consultation. Tarriffs are charged according to SAQA private rates.)

eClaims (Practice is authorised to submit claims directly to medical aid, on your behalf, as a courtesy. Patient remains responsible for the account until such time that it is settled in full.)

Name *

First Name

Last Name

Date of Birth *

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DD

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Phone *

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What service is your booking for?

Eye Test

Lenses / Frames

Reading Glasses

Specialised Contact Lenses

Sunglasses

Promotions

Paediatric Eye Examinations

Other