Dr Riaz Live Booking

Johannesburg Booking

Microclot Analysis Booking and Payment Form
Dear Patient

Please not the following:

The analysis is based on the latest data and research available and may be subject to ongoing improvement.

Biocode does not diagnose or recommend treatment for any condition or disease.

The interpretation of these test results should be made by the ordering/referring healthcare provider, and patients are advised to discuss the test results with their healthcare provider.
1. Patient Information
Name*

First NameLast Name
ID Number/ Passport Number*
Email*
example@example.com
2. Referring doctor
Your results will be shared with you via your specified referring doctor. Biocode will not discuss your results directly with you.

If your doctor is in our network, please select them from the dropdown list.

For doctors not listed, please provide their name and contact details.
Select a doctor from our network
Referring doctor*
Specify a doctor outside our network
Doctor Name and Surname

First NameLast Name
Practice Email
example@example.com
Practice Phone Number
Please enter a valid phone number.
3. Booking
Please select a time slot for your blood draw at, The Heart Wellness Center at 22 1st Ave, Houghton Estate, Johannesburg, 2196.

You will receive a booking confirmation and reference number via email. Please present the reference number to the nurse.

To change or cancel your booking, please submit your request via email to bookings@biocode.co.za.

It is important to note that cancellations must be made prior to your scheduled appointment in order to qualify for a refund.
Appointment*
3.Payment
Please note:

This is a specialised, novel analysis. As such, payment for the test and services cannot be claimed against a medical aid.
My Products*
prevnext( X )
Microclot Analysis
1,800.00ZAR Quantity

Transport Fee
200.00ZAR Quantity

Total

0.00ZAR
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Johannesburg Booking

1. Patient Information

2. Referring doctor

Select a doctor from our network

Specify a doctor outside our network

3. Booking

3.Payment