Patient Info (A)

Title:

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Surname:

First Name(s):

Nickname:

Which best describes you?

Identity Type:

RSA Identity Number:

Date of Birth:

Patient Info (B)

Residential Address:

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Telephone (Home):

Telephone (Work):

Cell Number:

Email:

Patient Info (C)

Allergies:

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Do you use any tobacco or nicotine products (including cigarettes, vaping or hubbly/shisha)?

Yes No

Family Medical History (if known):

Employer Name:

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Medical Aid Info (A)

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Medical Aid Info (B)

Same as the Patient

Main Member Surname:

Main Member Name(s):

Main Member RSA ID Number:

Main Member Cell Number:

Main Member Email:

Responsible Party

Same as the Patient Same as Main Member

Name:

Surname:

Cell Number:

Email Address:

Next of Kin

Name and Surname:

Relationship to Patient:

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Upload Supporting Documents

For faster onboarding, please upload your supporting documents below. Your identity document is required: upload your RSA ID (SA citizens) or your Passport (foreign nationals). If you’re unable to upload now, you may bring the documents to the practice — just tick the box below.

I will bring the requested documents with me to the practice

📄 Upload RSA ID Document or Passport Based on your ID Type selection: RSA ID (SA Citizen) or Passport (Foreign National). Required unless you tick “I will bring documents instead”. Max 5MB • PDF, JPG, PNG.

📄 Upload Medical Aid Card (if applicable) Max 5MB • PDF, JPG, PNG.

Terms of Service

Updated: 2026-10-25 04:39 SAST

Terms Policies Patient Use Admin Requests

1. Introduction

These Terms govern your use of 4FR Health services and digital platforms. By booking, using, or receiving care, you accept these Terms and all linked policies.

Effective date: 22 September 2026 .

Policy Hierarchy & Interpretation

These Terms of Service form the primary and governing agreement between 4FR Health and its patients. All other policies are incorporated by reference and must be read together with these Terms.

In the event of any conflict, inconsistency, or ambiguity between policies, the following order of precedence applies:

Terms of Service
Privacy Policy
POPIA Compliance Policy
Reception Scope & “Pre-Consulting” Policy
Prescription Fulfilment Policy
Cancellation & No-Show Policy
Afterhours Telehealth Service Policy

Service-specific policies apply only where relevant and do not override these Terms unless expressly stated. Where legislation imposes stricter obligations, the applicable law prevails.

2. Privacy & POPIA

We process personal information in accordance with our POPIA Compliance Policy and Privacy Policy.

Compliance queries: compliance@4fr.co.za

3. Medical Records & Retention

Adults: retained for at least 6 years.
Minors: until age 21 and 6 years of inactivity.

4. Prescriptions

Prescription services are subject to the Prescription Fulfilment Policy, including legal requirements for Schedule 6 medicines and follow-up prescription or medication requests made after a consultation.

4FR Health does not dispense take-home medication or operate a patient dispensary. Where medication is clinically indicated, a prescription is issued for fulfilment by an external pharmacy. Medication availability, pricing, and dispensing are the responsibility of that pharmacy.

5. Administrative Requests & Follow-up Documentation

Patients are encouraged to raise all medication, prescription, and sick note requirements during the consultation itself. This allows the doctor to assess the request properly, document it correctly, and avoid unnecessary follow-up administration.

The following requests may be billed separately:

Extension of a sick note after the conclusion of the original consultation.
Sick notes requested after the conclusion of a consultation, where the patient declined the issuance of a sick note, or forgot to request a sick note during the consultation.

Prescription-related follow-up requests are dealt with in the Prescription Fulfilment Policy.

Reason: These requests still require clinical review, administrative processing, and appropriate record keeping.

6. Cancellations & No-Shows

Notice periods, applicable fees, and exemptions are set out in the Cancellation & No-Show Policy.

7. Afterhours Telehealth

Afterhours services are governed by the Afterhours Telehealth Service Policy. Key terms include:

Prepaid online booking; base fee per professional guidance.
Invoice/statement for medical-aid reimbursement: R50.00.
Consultations: 15 minutes (plus 5-minute admin buffer), one primary condition only.
No scheme submissions by 4FR Health; reimbursement may be lower than the fee charged.
Telehealth may require an in-person follow-up.

8. Payments

Unless otherwise stated, fees are due on the day of service. Claims to medical aid are subject to scheme rules and benefits.

9. Changes

We may amend these Terms and linked policies from time to time. Continued use of our services constitutes acceptance of changes.

10. Contact

Practice queries: hello@4fr.co.za | Compliance: compliance@4fr.co.za

Sign inside the box
(or upload signature)

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Patient Info (A)

Patient Info (B)

Patient Info (C)

Payment Option

Medical Aid Info (A)

Medical Aid Info (B)

Responsible Party

Next of Kin

Upload Supporting Documents

Terms of Service

1. Introduction

Policy Hierarchy & Interpretation

2. Privacy & POPIA

3. Medical Records & Retention

4. Prescriptions

5. Administrative Requests & Follow-up Documentation

6. Cancellations & No-Shows

7. Afterhours Telehealth

8. Payments

9. Changes

10. Contact

Related Policies

Compliance Documents

Patient Signature