Your privacy / This form asks for personal and health information so that we can prepare for your eye examination, keep your patient record and, where applicable, claim from your medical aid. Only our practice team sees it, and it is kept confidential.

The form is provided by Google Forms, so your answers are stored on Google’s servers, which may be outside South Africa. By submitting the form, you agree to us processing your information as described in our Privacy Policy. If a patient is under 18, a parent or guardian must complete the form. If you would rather not complete it online, you can fill in a paper form at the practice.