Bookings

Available Services

All consults includes, medical certificates, prescription and or referrals

NB: Medical aids accepted

General Consultation

R300

Acne/hyperpigmentation Consultation

initial consult (R500)
Follow-up (R300)

Weight Loss Consultation

initial consult (R500)
Follow-up (R300)

Mental Health Consultation

initial consult (R500)
Follow-up (R300)

Select Appointment Date

What time of day would you prefere for your appointment

consultations are 20 minutes

Morning
(08:00-08:30)

Midday
(11:00-11:30)

Afternoon
(13:00-13:30)

Evening
(17:00-17:30)

Sunday
(15:00-19:00)

Are you a new or an Existing Client

Existing Client

New Client

Who is this Apointmet for

Adult

Child

Patients Name and Surname: ID Number: whatsapp Phone number: Reason for consult:

Child's Name and Surname: Parent ID Number: Parent whatsapp Phone number: Reason for consult:

Patients Email: Patients Name: Patients Surname:

Gender:

Male Female

Marital Status:

Single Married
ID/Passport: Date of Birth: Patients whatsapp Number: suburb,town or city: Allergies: Chronic Illnesses: Current Medication: Reason for consult:

Parent Email: Child's Name: Child's Surname:

Gender:

Male Female
Parent ID/Passport: Child's Date of Birth: Parents whatsapp Number: Residential address (suburb,town or city,Postal Code): Child's Allergies: Child's Chronic Illnesses: Child's Current Medication: Reason for consult:

Preferred Platform:

WhatsApp video call WhatsApp text WhatsApp voicecall Other

Consent form

Please confirm your understanding and consent:

I hereby (consent) to the Telemedicine consultation with Bless Health Med as per the HPCSA guidelines.

Only relevant, personal and medical information is collected for your care.
Your information is securely stored and will not be shared without your consent.
Your data and information is handled securely according to the POPIA act for more info refer to our

For more information on how we handle your data, please refer to our Privacy Policy.

Payment method

I understand and agree to the consultation fee payable via EFT or YOCO before the consultation

NB: may you please send proof of payment to my WhatsApp or pay via yoco link after submitting form.

Medical Aid Information

I will be using medical aid for the virtual consultation.

Consult fee is paid according to schemes rates.

Name of Medical aid Medical aid number

Available Services

General Consultation

Acne/hyperpigmentation Consultation

Weight Loss Consultation

Mental Health Consultation

Select Appointment Date

What time of day would you prefere for your appointment

Morning(08:00-08:30)

Midday(11:00-11:30)

Afternoon(13:00-13:30)

Evening(17:00-17:30)

Sunday(15:00-19:00)

Are you a new or an Existing Client

Existing Client

New Client

Who is this Apointmet for

Adult

Child

Gender:

Marital Status:

Gender:

Preferred Platform:

Consent form

Please confirm your understanding and consent:

Payment method

Medical Aid Information

Morning
(08:00-08:30)

Midday
(11:00-11:30)

Afternoon
(13:00-13:30)

Evening
(17:00-17:30)

Sunday
(15:00-19:00)