For added convenience and to save time, you can download all the required patient and surgical forms here.

BOOKING AN APPOINTMENT

Bookings are now done electronically by clicking the Appointment Request button below. You can select the surgeon you wish to see on the online form that appears. For appointments with Prof Lubbe, kindly read the requirements below.

Dr Goncalves

Complete and submit the online form by clicking the button below. On receipt of your request, we will contact you to arrange your appointment.

Prof Lubbe

To request an appointment with Prof Lubbe, you will need to provide:

  1. A referral letter from a specialist.
  2. All scans of the problematic region (CT or MRI) if already performed.
  3. Histology results (if available)

You will be prompted to upload these items before you submit the form. On receipt of your request, we will contact you to arrange your appointment. 

BEFORE YOUR FIRST APPOINTMENT

Due to our Covid-19 safety precautions, appointments are conducted virtually, where possible. Kindly complete and submit the New Patient form prior to your appointment.

If your appointment requires a physical visit to our consulting rooms, the Covid-19 Disclosure form must be completed prior to your appointment. You can email the completed and signed form to us on the day, or bring a printed and signed version along with you.

NEW PATIENT FORM

Complete Online

COVID-19 DISCLOSURE

Download PDF

BEFORE YOUR SURGERY

Kindly download and complete all the forms below, prior to your surgery.

  • Pre-surgery Info: This form should be downloaded and read as soon as possible. It contains important pre-surgery information, including medical aid authorisation requirements, medication information, account information, and more.
  • Surgical Consent: This form details the kind of surgery that will be performed, and the associated risks.
  • Evidence of Consent: This is the hospital form detailing the kind of surgery being performed, which must be signed by both patient and doctor.
  • Mediclinic Admission: Completing this form prior to admission will help streamline the admission process.
  • Covid-19 Disclosure: This form must be completed prior to admission.

PRE-SURGERY INFO

Dr Goncalves – Download PDF
Prof Lubbe – Download PDF

SURGICAL CONSENT

Dr Goncalves – Download PDF
Prof Lubbe – Download PDF

EVIDENCE OF CONSENT

Download PDF

HOSPITAL PRE-ADMISSION

Complete Online

COVID-19 DISCLOSURE

Download PDF