Call back Request
Please fill out this form to start your care with us.We ask for basic information such as your name, email address, phone number, and the reason you are requesting a call back. This helps us prepare for contact, assess your request, and where relevant, validate your medical aid details before your appointment.Your information will be handled in line with POPIA and used only for legitimate care, administration, and follow-up purposes within our service. We take reasonable steps to protect your personal information and limit access to authorised team members involved in your care or booking process.We aim to contact you within 48 hours. If you do not hear from us within that time, please send a WhatsApp message to 066 499 2713 so your request is escalated to a human for prompt attention.
Name
*
First Name
Last Name
Which service centre do you want to book your appointment
Woodmead
Busamed Modderfontein Hospital
Pretoria
Virtual
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for appointment
*
Please Select
Maternity booking, I am pregnant
Routine Gynae check, I have no issues ( e.g. for Pap smear)
Gynae check, I have a gynae problem (fibroids, menstrual, hormonal, infertility other)
Other reason
Pap smear Campaign (PROMOTION)
If other fill out details below
If you chose other, please give details. Include any other important medical or social factors to consider.
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