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patient information form

Next of Kin(not from the same physical address)

ALL FIELDS WITH * ARE MANDATORY.

PLEASE NOTE THAT YOU (OR YOUR PARENT/GUARDIAN) REMAIN LIABLE FOR THE ACCOUNT FOR SERVICES RENDERED BY THIS PRACTICE, EVEN IF YOU ARE INSURED BY A MEDICAL AID OR OTHER THIRD PARTY.

PLEASE ENSURE THAT YOU HAVE READ AND SIGNED THE ATTACHED DOCTOR-PATIENT CONTRACT.

We are moving!

We would like to let you know that Dr Frits Spruyt’s practice is relocating. From 25 March 2026, our new home will be:

1st Floor, 273 Tram Street Nieuw Muckleneuk, Pretoria

Please update your records to ensure all future deliveries and correspondence reach us at this new address.

Note: Our contact numbers and email addresses remain exactly the same. We look forward to seeing you at our new rooms soon.

South Africa’s Protection of Personal Information Act (POPIA) & Cookie Consent

We will not sell, share, or rent your Personal Information to any third party or use your email address for unsolicited mail. Any emails sent by us will only be in connection with the provision of our services and/or the marketing thereof. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By continuing in the website you accept the use of cookies.

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FOR INFORMATION ABOUT COVID-19 VISIT:

SOUTH AFRICAN GOVERNMENT'S
COVID-19 PORTAL