MEDICAL AID CLAIMS
- Please provide us with your Medical Aid Card/Number.
- I understand that:
The responsibility for confirming funds and obtaining authorisation for treatment lies with the patient. Ask for a quotation if you wish to confirm available funds and/or procedures covered. A Dental examination (x-rays at an additional charge) is required before any quotations can be made.
PRIVATE / HOSPITAL PLAN OPTION
- No accounts/ payment plans for any dental procedures.
- All laboratory fees must be paid in full prior to delivery.
ALL PATIENTS
- This accountability results from the contractual relationship between Dr. Blignaut and myself. All accounts are claimable and payable within thirty (30) days after delivery.
- Interest will be charged at a rate of 18 % per annum on all accounts not settled within thirty (30) days.
- I accept responsibility for paying all costs during the account collection from me on a scale of Attorney and Client, as well as VAT and collections commission. I also accept responsibility for paying any tracking costs and expenses that may be incurred.
- My address, as set out for purposes of summons and other documents, will be my chosen domicilium citandi et executandi. The mentioned domicilium may be changed with registered post 14 days before it changes.
- Cancellations within two hours of your appointment may be charged at R350 per 30 minutes appointment.
- Please make use of our WhatsApp number 0769174857 for any communication.
- Office Hours: Monday to Friday 08:00-15:30