Optometrist welcoming a patient at the front desk

Patient registration

Register and book your eye test.

Complete your registration once, choose your branch, and finish by confirming your appointment time on WhatsApp.

Choose your branch

Spectra Vision branch

Your registration goes to this branch, and the WhatsApp booking opens this branch's chat.

Main member or person responsible for account

Surname *

Title

First name(s) *

Initials

Postal address

Postal code

Home address

Home postal code

Telephone (work)

Telephone (home)

Cell phone *

2nd cell phone

Email *

Occupation

Employer

ID number

Date of birth

Medical aid details

If applicable.

Medical aid name

Medical aid number

Medical aid plan

Dependent code (if applicable)

Patient details

Only if different from the main member.

Surname

Title

First name(s)

Medical aid number

ID number

Telephone (work)

Telephone (home)

Cell phone

Occupation

Date of birth

Emergency contact / next of kin

Name & surname

Telephone (work)

Cell phone

Relationship to you

Consent & agreement

Spectra Vision Optometrists protects your personal information in line with the Protection of Personal Information Act (POPI). Your details are used to keep an accurate medical record for diagnosis, billing, scheduling and follow-up care, and are never sold or rented. Read the full terms in our policies.

I consent to Spectra Vision collecting and using the information above in accordance with POPI legislation, and confirm I have the consent of any other person listed.I have read and accept the payment, medical aid and liability terms, and confirm all information provided is true and accurate.

Each Spectra Vision Optometrists location is individually owned and operated. The full payment and liability agreement is signed in branch at your appointment.

We store your registration securely and open a short WhatsApp booking message, no ID or medical details are sent over WhatsApp.

Register and book your eye test.

Main member or person responsible for account

Medical aid details

Patient details

Emergency contact / next of kin

Please contact me

Tell us how you heard about us

Consent & agreement