Specialist urologist · Ballito
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Dr. Eneshra PadayacheeUrology Inc.Book appointment
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New patients

Prepare before you arrive.
Register with confidence.

Complete your registration online or download the printable practice form before your first appointment.

01

Printable document

Download the original form.

Prefer to complete the paperwork by hand? Download the practice’s supplied one-page registration form, print it and bring it to reception.

Download patient form · PDFPreview document in a new tab ↗
02

Online registration

Complete it online.

Use the guided form below to enter the same administrative information. Required fields are clearly marked and the form works on mobile devices.

Start online form ↓
Before you start

Have the main member’s details, medical-scheme information and next-of-kin contact details available. Allow approximately 8–10 minutes.

Patient registration

Your details,
clearly organised.

Fields mirror the supplied practice registration document. Information is used only to prepare your patient record and administer your account.

01

Account holder

Main member information

Complete this section for the principal member responsible for the medical-scheme account.

Gender
Email statements?
GAP cover
02

New patient

Patient information

Enter the details of the person who will be consulting with Dr Padayachee.

Gender
Use this number for appointments and results?Required
03

Emergency contact

Next of kin

Please provide someone who does not live at the same physical address.

04

Confirmation

Declaration and consent

Please review your details before submitting.

I confirm that the information supplied is true and that I am responsible for any false information provided. I understand that the patient, parent or guardian remains liable for the account for services rendered by the practice, even when insured by a medical scheme or another third party.

The original registration document refers to a separate Doctor-Patient contract. Reception will advise if an additional signature is required.

Allow general practice notices and mass communication?Required
Your privacy matters.

This form contains identity, contact and medical-scheme information. Submit it only from a private device and trusted connection. Do not use this form for medical emergencies.