Mediclinic Cape Gate welcomes your vaccination booking

Mediclinic Cape Gate

Welcomes your vaccination booking

Important Notice:

Please take note that vaccination will only be possible with a Vaccine Code and appointment as received from the Department of Health. Submitting information here does not confirm your eligibility for receiving a Covid-19 vaccine.Please arrive on time for your appointment as communicated to you via SMS by the Department of Health.

PERSONAL INFORMATION

Vaccination Date

(as received from Department of Health)

Cellphone Number

Title

Initials

First Name (s)

Surname

ID Type

South African ID Number

Date of Birth

Gender

Street

Suburb

City

Country

MEDICAL AID INFORMATION

DO YOU HAVE MEDICAL AID?

Yes No

Medical Aid

Medical Aid Plan

Medical Aid Number

IS THE PATIENT ALSO THE MAIN MEMBER?*

Yes No

I cannot find my medical aid

SUPPORTING DOCUMENTS (OPTIONAL)

Please take note:

If you do not have or cannot upload the required documents. Please bring a copy of your ID and medical aid card to the vaccination site.
All documents must be in pdf, jpeg or png format, with a maximum size of 6 MB each.

RSA Id Type

Smart ID Card Green Barcoded ID Drivers License

Smart ID Card (Front). Max. 6 MB

Smart ID Card (Back). Max. 6 MB

Medical Aid Card (Front). Max. 6 MB

Medical Aid Card (Back). Max. 6 MB

I herewith confirm that the information provided is correct.

I acknowledge that I have read and agree to the Terms and Conditions