Patient Details: New Patients

Please complete this form with your first online booking in just a few steps.

Important information about visiting our Practice

We appreciate your business approach to time. Health is our first priority and our approach to time is dedicated to your health. Drs Conradie and Urry Inc is a Specialist Urologist Practice and they spends most of their time in surgery, often with life and death emergencies. Please be patient when you arrive at our Practice.

  • First Consultation: R1600.00 – member to claim back from Medical Aid
  • Follow up Consultation: R900.00 – member to claim back from Medical Aid

The questions that follow are specific. Please complete the whole questionaire in order for us to streamline consultations with relevant information of your bladder and kidney functions. When you have nothing to report, please be so kind as to mark the answer as ‘not relevant’.

All information is strictly confidential. We are taking every precaution to respect your privacy.

 

Our main practice is situated at:

Netcare Waterfall City Hospital, South Block, Suite 211, Corner Magwa Crescent and Mac Mac Avenue. Midrand, Gauteng.

When you book online we will send you an email confirmation.

 

Please contact us at 011-304 6781 if you have any questions prior to your consultation.

  • Patient Details

  • Date Format: YYYY dash MM dash DD
  • Responsible for account - Main Medical Aid Member

  • Medical Aid Details

  • Next of kin / Friend / Relative residing at different address

  • VERY IMPORTANT TERMS AND CONDITIONS
    Dr MC Conradie – Billing Policy
    • The first consulation for all patients are payable immediately for member to claim back from Medical Aid.
    • Please take note that we are charging Discovery Classic rate which is 217%. Member will be liable for the portion not covered by the medical aid.
    • For code 1807 will be for all Laparoscopic procedures at 500%. Member will be liable for the portion not covered by the medical aid.
    • I understand that payment of services rendered remains my responsibility and that the practice does not necessarily charge contracted fees.
    • Patients are billed in full when they do not cancel appointments within a reasonable time that is made online.
    • As of patients of this practice, you give permission that medical information be shared for the purposes of running this practice.
    I agree that should my account be handed over for collection, I shall be liable for all attorneys and own client fees, collection charges and all disbursements. I agree that the account and payment of account is subject to the Prescribed Rate of Interest Act and that I remain liable for more interest on accounts that have not been settled within 60 days. I agree to inspection of and negative listing of my credit information should my account remain outstanding. I choose the above address as my domicile. It is agreed and understood that all information regarding the treatment and patient will be treated confidentially and not disclosed other than with a Court order or written consent from the legal guardian(s). Further do I hereby accept the terms and conditions as set out herein.