Register your practice

First Name *

Surname *

HPCSA Number *

Qualifications *

Name of Practice *

Billing Practice Number *

The number you bill medical aids under, also called the group practice number.

Private Practice Number * I only have one practice number

If you only have one, it's the same number in both fields.

Practice Address Line 1 *

Practice Address Line 2

Postal Code *

Provider Cellphone *

Provider Email *

Practice Phone *

Practice Email *