Orthopaedic Appointments

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.

Required fields *

First Name

Last Name

Mobile Phone

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

Andries de Viliers is a highly accomplished orthopaedic surgeon with a long standing commitment to outstanding patient care.