Are you a new Patient?

Follow the instructions below to register.

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Are you a new Patient?

Follow the instructions below to register.

Scroll Down

1. Click on the link below to download the form.

2. Download and/or Save the document on your computer/device. By saving the document it enables you to enter the fields digitally, without having to print the form and complete manually.

 

3. Complete the PDF with all of your information by clicking on each section, typing in details and marking with an x for selecting an option.

4. Save the completed PDF document once again on your computer/device, and email through to the practice you would like to visit.

PRETORIA

Email completed form back to:   reception@orthodontist.co.za

 

 

BENONI

Email completed form back to:   benorth@orthodontist.co.za

 

 

MIDDELBURG

Email completed form back to:   midrecep@orthodontist.co.za

 

 

1. Click on the link below to download the form.

2. Download and/or Save the document on your computer/device. By saving the document it enables you to enter the fields digitally, without having to print the form and complete manually.

3. Complete the PDF with all of your information by clicking on each section, typing in details and marking with an x for selecting an option.

4. Save the completed PDF document once again on your computer/device, and email through to the practice you would like to visit.

PRETORIA

Email completed form back to:   reception@orthodontist.co.za

BENONI

Email completed form back to:   benorth@orthodontist.co.za

MIDDELBURG

Email completed form back to:   midrecep@orthodontist.co.za