Ampath Genetics Clinic
167 Witch Hazel Avenue, Highveld Park, Centurion, 0159
geneticsclinic@ampath.co.za
www.ampath.co.za
+27 (012) 678 0645
Request an appointment
Your Full Name:
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First Name
Last Name
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Format: (000) 000-0000.
E-mail:
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Who is the appointment for?
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Yourself
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Patient details (if appointment is not for yourself):
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Patient's date of birth:
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Where does the patient currently stay?
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Eastern Cape
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Reason for appointment:
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Preconception counselling
Prenatal
Cancer genetics
Adult genetic condition
Paediatric genetic condition
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Please provide the provisional diagnosis / main problem:
Referring medical practitioner:
Not essential for appointments with a genetic counsellor.
Do you need to see a medical geneticist or genetic counsellor:
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Genetic counsellor
Medical Geneticist
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Would you prefer an in person or virtual appointment:
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In person
Virtual
Note virtual appointments are not possible when the patient requires a clinical examination.
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