Special Medicals Request

Medicals - Request Form

Please use this form to request insurance, occupational health, company, travel/visa, or other special medicals. All requests are handled securely and in accordance with POPIA regulations.

First Name(s)

Surname

Email Address All correspondence and confirmations will be sent to this address.

Mobile Number

Employer | Insurer | Broker Name

I consent to be contacted via WhatsApp

The medical is for:

Type of Medical Required

Notes to Medical Practice

Upload Supporting Documents

You can upload any supporting documents now (PDF, TIFF, PNG, JPG, DOC, DOCX). Each file must be ≤ 5 MB. If you cannot upload now, tick the box to bring or email them later.

I will bring or email the documents later

📄 Document 1 Max 5 MB • PDF, TIFF, PNG, JPG, DOC, DOCX.

Important Terms for Medicals

Medicals must be booked as a stand-alone appointment and cannot be combined with other consultation types.
All supporting documents must be reviewed by our team before a booking can be confirmed.
Please note that certain assessments may be conducted by a nurse rather than a doctor.
We only claim directly from insurers with whom we have existing agreements. For all other insurers, patients are required to pay upfront and claim back directly.
For company medicals, travel medicals, nursing home medicals, and occupational health medicals, a quotation will be issued prior to booking. Payment must be made by card on the day of consultation or via EFT before the appointment.
A valid identity document must be presented at all medical appointments.
Medicals are scheduled with the available doctor or nurse on duty. Patients may not select a specific practitioner for these appointments.
All bookings are subject to 4FR Health's Terms of Service and related Policies.

I confirm that the information provided is true and correct.