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Smit & Winkel

Book an appointment

Click here and fill in a form to make an appointment

New Patient?

Save some time and fill in a New Patient Registration Form online

Office Hours

Monday-Thursday:
7h30-17h30
Fridays:
7h30-17h00
Saturdays:
(Only oral hygienist by appointment)
7h30-11h30

Patient Information Sheet

Patient Information Sheet
PERSON RESPONSIBLE FOR ACCOUNT.
Title
Initials (*)
Surname (*)
Physical Address
Postal Address
Home nr
Work nr
Cell nr (*)
Medical Aid
Medical Number
ID number
Occupation
Employer
E-mail (*)
Nearest Family/Friend name
Relationship
Address
Code
Phone Number
CellNumber
Recommended By

Book an appointment

Click here and fill in a form to make an appointment
 

New Patient?

Save some time and fill in a New Patient Registration Form online
 

Office Hours

Monday-Thursday:
7h30-17h30
Fridays:
7h30-17h00
Saturdays:
(Only oral hygienist by appointment)
7h30-11h30