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Consultation

Please fill in form below:

    1. Patient

    Date of birth

    2. Person responsible for Account

    3. Medical Aid

    4. Family member or Friend (not same address)

    5. Referred By



    Please Fill In Covid-19 Protocol Form Below:

    Dear beloved patient

    Please complete this form and submit it with confirmation of your treatment procedure.

    I hereby give consent to the Dermatologist at CDC to perform a consultation / treatment procedure on me. I understand that CDC has strict regulations in place to limit the spread of Covid-19.

    It is of the utmost importance that you do not present any of the following:
    • Slight cold
    • Flu
    • Sore throat / cough
    • Temperature of above 37.5°C
    • Definite loss of smell and taste
    • Were in contact with anyone who tested positive for Covid-19 during the past 14 days.

    Kindly be informed of the following protocol we are currently taking at CDC:

    1. Please arrive for your appointment exactly on time.
    2. Parking is available in front of our building. Be so kind to wait in your vehicle until your treatment if you are a few minutes early. Please leave your handbag in the car and only carry a small item such as your wallet.
    3. You will be personally greeted at the door by the Dr’s assistant.
    4. Please wear your own face mask.
    5. Your temperature will be tested.
    6. The Doctor’s assistant will hand you a pair of overshoes to wear and sanitize your hands.
    7. You will be escorted to your immediate treatment room.

    Should you test positive for Covid-19 in the next 7 days, kindly inform us.

    Our therapists and doctors are currently working in two separate groups. We kindly request that patients don’t visit both doctors / therapists from opposite groups within 1 week to avoid possible cross-infection.

    Product sales:

    • Kindly advise your Doctor’s assistant during your appointment should you have the need to purchase any products and she will gladly get your parcel ready for you.

    Payment options:

    • Payment may be done at our practice with credit card – CDC will take the necessary measures to sterilize.
    • EFT can also be done 3 days prior to your treatment (please make sure of the exact amount and notify our reception by contacting us).
    • Unfortunately, no cash payments will be accepted at this time.

    Please know that every candle we light at CDC signifies the love and care we have for you as our patient.
    Feel free to notify us should there be anything more we can do to make you feel comfortable and safe at our practice.

    For any questions please do not hesitate to contact us: capedermteam@gmail.co.za. Follow us on Facebook and Instagram for any updates.

    View our privacy policy here

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