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The Helderberg Family Practice

Terms and Conditions of Service

  1. The agreement for rendering professional services is between the doctors and yourself/family. Medical aids are not contractually bound to the doctors. It, therefore, remains your responsibility to follow up on your account and to settle within 30 days from the date of service, if not already done so by your medical aid.

  2. All accounts please to be settled immediately unless being submitted to medical aids for processing.

  3. Should an invoice remain unpaid for a period of 90 days from the date of service, the matter will be handed over for collection

    by a firm of attorneys and the cost of the collection will be for your account and will be charged per the National Credit Act.

  4. Please keep the practice informed of any changes to your contact details, and particularly the address where you agree to receive all invoices, documents, and other written correspondences (domicilllium citande et executandi).

  5. Booked appointments that are not canceled within 2 hours of the appointment may be charged a fee. This fee is not covered by medical aid and will be for your account.

  6. Invoices and statements of account containing the ICD-10 diagnosis codes will be provided by this practice. I authorise my doctor to provide my medical aid with my personal medical information for the purposes of administering claims.

  7. I authorise my doctor to destroy records if they have been inactive for longer than 6 years (adults) or in minors, after having reached 21 years of age and the patient file been dormant for the preceding 6 years.

  8. POPI COMPLIANCE CLAUSE: I hereby consent to the processing of my personal information contemplated in the Protection of Personal Information Act No 4 of 2013, by Dr C Vamvadelis & Dr D Reed, the practice staff and third parties with whom Dr C Vamvadelis & Dr D Reed have a contractual relationship with for the following purposes:

    • Treating and managing me in terms of a doctor and patient relationship

    • The administration of the contractual relationship between myself and                         Dr C Vamvadelis & Dr D Reed

    • Communicating with other persons in as much as it relates to my treatment and management

    • Communicating with third parties who have undertaken to indemnify me for the costs of my treatment and management or part thereof, including all medical schemes and their administrators where relevant

    • Collecting monies outstanding from me.

  9. Declaration by patient/parent/guardian

      By checking the box in the New Patient Registration form below I confirm that:

  • I have read and understand the terms and conditions of service as set out in this agreement above.

  • I confirm that the information supplied is correct.

PLEASE NOTE: This form can also be manually completed at our practice or requested in Pdf format beforehand via or 021 205 1146

Helderberg Family Practice
New Patient Registration

Thanks for registering!

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