Long-Term Care Enquiry Form
We strive to respond to all enquiries within 1-2 working days.
Full Name
First Name
Last Name
Email
*
Contact Telephone Number
Healthcare Centre
*
Please Select
Tokai
Bridgewater Manor
Heritage Manor
Onrus Manor
Cle Du Cap
Noordhoek Manor
Other
Please select the Healthcare centre you wish to contact. If unsure select "Other"
Requirements:
Please Select
Long Term Care
Short Term Care
Not Sure
Current Facility/Hospital patient is in
Please clearly state enquiry details below:
How Did You Hear About Us?
*
Blog or Publication
Social Media
Recommendation/Word of Mouth
Search Engine (Google, Yahoo etc)
Other
Please verify that you are human
*
Submit
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