Patient Information

Do you have Medical Aid

Have you ever been or are you curently insolvent or under administration ?

I declare that the above-mentioned information is correct. I understand that if my account is not settled within 60 (sixty) days, the account will be handed over for collection and that I will be responsible for all costs incurred.

12 + 14 =

Patient Information

Dr Dawie Peens

Consulting room 102,
Lenmed Royal Hospital and Heart Centre,
Corner Jacobus Smit Avenue and Welgevonden Street,
Royldene, Kimberley, 8301.

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