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012 663 2010
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info@centuriondayhospital.co.za
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Office Hours: Monday to Friday 06:00 - 16:30 | Saturday 06:00-13:00
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Patient Space | Online Pre-admissions

Online Pre-admissions​

Please bring along the following documents:

  • Main member’s ID book.
  • Patient’s ID book.
  • Medical aid scheme card.
  • Doctor’s letter of referral.
  • Medical aid scheme authorisation number (we can assist with this if necessary).

The admission clerk will:

  • Help you complete all the relevant documents.
  • Assist you in obtaining authorisation from your medical aid scheme.
  • Collect the co-payments (if necessary) or private patient upfront deposit.
  • Explain the admission process.
For Online Pre-admissions please fill out the two compulsory online forms below:

1. Patient Questionnaire
2. Pre-Admission Form (Medical Aid or Private)

If you prefer to download, print, and fill in the forms manually – please click on the buttons below.
Email the completed form to admissions@centuriondayhospital.co.za and cc ellen@centuriondayhospital.co.za

Download Private PDF
Download Medical Aid PDF

    This information is crucial to the Anaesthetist

    Do you suffer from any of the following?
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    Pre-Admission Information
    Doctor’s Information
    Patient Details
    Person responsible for account
    Employer’s Detail (Person responsible for payment of account)
    Person to contact in case of emergency/Next of Kin (not someone that lives with you)
    Person responsible for account
    I hereby confirm all details supplied are correct and true
    Doctor’s Information
    Patient Details
    Details- Main member of Medical aid
    Employer’s Detail (Main member)
    Person to contact in case of emergency/Next of Kin (not someone that lives with you)
    Main member
    I give Centurion Day Hospital the authority to claim/submit the account on my behalf
    I hereby confirm all details supplied are correct and true

    QUICK LINKS

    FB2
    ig2

    GET IN TOUCH

    PHONE

    012 663 2010

    MAIL
    info@centuriondayhospital.co.za
    TIME
    Office Hours: Monday to Friday 06:00 – 16:30 |
    Saturday 06:00-13:00
    LOCATION

    192 A Glover Ave, Lyttleton,
    Centurion, 0157

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