AGREEMENT ENTERED INTO BETWEEN DOCTOR AND THE PERSON RESPONSIBLE FOR THE ACCOUNT

PLEASE READ THE TERMS AND CONDITIONS CAREFULLY BELOW

The person responsible for the account hereby agrees as follows:

  1. That (s)he is liable for the payment of the medical services provided by the doctor to the patient.
  2. To pay the minimum fee for a basic consultation. Complicated consultations requiring more time or any procedures, will add to the fee. A pop-in appointment of 5 minutes will be charged and there will be a charge for repeat scripts.
  3. It is acknowledged that Dr. Nomphelo Gantsho’s tariffs for procedures, as well as for other mis- cellaneous consultative services, are approximately 2 - 3 times more than the National Health Refe- rence Price List (NHRPL) tariff.
  4. If (s)he has medical aid cover, then the amount the scheme is prepared to reimburse will depend on that particular scheme. An administration fee is paid upfront.
  5. To settle the doctor’s account in full immediately after your appointment on the same day, irres- pective of any contracts (s)he may have with the medical aid scheme or any third party.
  6. A receipt will be issued on payment of the account and this can be used to claim back from the medical aid.
  7. We require a minimum of 24 hours cancellation notice. Missed appointments or late cancellations will otherwise be charged a full consultation fee.
  8. Failure to settle your account promptly will result in the account being handed over to a debt col- lecting agency. You will be liable for all additional costs that this may incur, including commissions and tracing costs.
  9. Any specimens taken for analysis will be sent to a laboratory or pathologist. The cost for analysis of the specimens are not included in the consultation and the patient or main member of the medical aid will be responsible to settle this with the 3rd party.
  10. Only one patient will be seen per consultation. Any other person should book separate consulta- tions.
  11. Any equipment or consumable used during procedures regardless of initial consultation, follow- ups or pop-ins will be billed for accordingly.
  12. During a normal consultation the dermatologist will deal with your main complaints, if any others, she will try to fit a maximum of 2 other problems if possible within the time allocated for the consultation. Otherwise this will need to be dealt with in another consultation or a longer initial consultation must be booked.