REQUESTING AN APPOINTMENT Dear Patient,For your convenience you may request an appointment by filling out the below.Please upload your referral and any radiology examination. (eg, x-ray / MRI reports as part of your request)We will contact you shortly to schedule an appointment for you. REQUEST APPOINTMENT Required fields * First Name Last Name Mobile Phone Email Do you have a referral from your GP? Yes No Do you have current X-Ray/MRI/CT Scan (within three months)? Yes No Upload GP Referral Upload X-Ray/MIR/CT Scan Do you have private Health Cover? Yes No Injury Comments Submit New Patient Registration Form Andries de Viliers is a highly accomplished orthopaedic surgeon with a long standing commitment to outstanding patient care.