To be completed by any persons between the ages of 12 and 18, that has sufficient mental and emotional maturity to understand the consequences of providing their own consent.

To be completed by any persons between the ages of 12 and 18, that has sufficient mental and emotional maturity to understand the consequences of withdrawing their consent.

Completing this form will allow the doctors to access any previous medical records. If consent is not granted the patient will have to obtain the records for the doctor.

Completing this form you withdraw consent for the doctors to access any previous medical records. If consent is not granted the patient will have to obtain the records for the doctor.

By completing this form you are allowing our accounts departments to submit all claims to medical aid on your behalf. 

By completing this form you are withdrawing consent for our accounts departments to submit all claims to medical aid on your behalf.