Admissions

Being admitted to a M-Care Facility?

We take pride in the services we offer and are committed to being active partners in your treatment. However, we need you to be just as active in this partnership.

Please fill in the form below, on admission, we will ask you to sign the terms and conditions form.

    GENERAL INFORMATION

    Date of Admission

    Hospital

    Admitting Doctor

    PATIENT PARTICULARS

    MEDICAL AID PARTICULARS

    PRINCIPAL MEDICAL AID MEMBER AND /OR PERSON RESPONSIBLE FOR PAYMENT OF ACCOUNT

    CONTACT DETAILS OF A FRIEND / RELATIVE NOT RESIDING WITH YOU