Kindly note that all personal, sensitive, and health data collected shall be processed in accordance with the Data Privacy Act No 24 of 2019. For more information on your rights and responsibilities, please check our data privacy policy here, or request for a data privacy pamphlet at your clinic. Read our Data Privacy Statement.

MAKE YOUR BOOKING

Details of the Child

First Name:

Last Name:

DOB:

Gender -- Select Gender -- Male Female

Area Of Concern:

Does the child attend school?:

Yes No

If yes, enter the name of the school:

Parent/Guardian Details

First Name:

Last Name:

Telephone:

Where do you reside?:

Booking Speciality: -- Select Speciality -- AUDITORY AUTISM ID LD OCC/PHY THERAPY SPEECH AND LANGUAGE VISION

Select Appointment Date:

Select a Time Slot: -- Select Time Slot --

Book Appointment