Specialised Day Surgery Cure Day Clinics
Find a Doctor

FIND A
DOCTOR

Online Pre-admissions

ONLINE
PRE-ADMISSIONS

Online Pre-admissions

PATIENT
ZONE

online pre-admissions

Doctor’s Information  
   
Please complete - Full details of patient  
 
   
Person responsible for account (Main member of Medical Aid)  
 
   
Employer’s Detail (Main member/Person responsible for account)  
 
   
Person to contact in case of emergency/Next of kin   (Different address and tel)
 
   
Main member / Person responsible for account  
give Cure Day Clinic the authority
(Medical Aid),
 
   
PREOPERATIVE SCREENING CHECKLIST
    (For office use)
   
QUESTIONNAIRE Kindly select the relevant box or provide us with the necessary information:
CURRENT MEDICATION HISTORY (list all that apply, including herbal supplements and over-the-counter medication)
MEDICATION DOSE COMMENTS
   
Clinic details  
   
   

download pre-admission forms

pdf

CURE DAY CLINICS BELLVILLE

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CURE DAY CLINICS BLOEMFONTEIN

pdf

CURE DAY CLINICS ERASMUSKLOOF

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CURE DAY CLINICS FOURWAYS

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CURE DAY CLINICS MEDKIN

pdf

CURE DAY CLINICS MIDSTREAM

pdf

CURE DAY CLINICS SOMERSET WEST

pdf

CURE DAY CLINICS ST. STEPHEN'S PAARL