Forms Background Medical History

Consultation Background Medical History Form

Questionnaire to insure we understand your medical history

Your backround medical data is essential to providing you with safe and relevant management options whether conservative or surgical. If all data is not disclosed then we cannot be held responsible for outcomes relating to missing information.

Step 1 of 2

Book a Consultation:

Personal Assistant to Dr Munting

Merle Hermanus

+27 21 424 0725/6

Settle my Account:

Accounts & Admin

Sheneal Moultrie

+27 21 424 0726

Find Us:

Netcare Christiaan Barnard Memorial Hospital

25 D.F. Malan St, Foreshore,

Cape Town, 8001

Find on Map