Contact & Book an Appointment | Sampax Health 911

Get In Touch

Book, Register or Ask a Question

Choose an option below — everything you need before and during your visit.

Full Name *

Mobile Number *

Your Email *

Preferred Practice *

Preferred Date *

Preferred Time

Reason for Visit / Service Needed *

Additional Notes

I consent to Sampax Health 911 using the information provided to process my booking request, in line with the Privacy Policy.

This is a request, not a confirmed booking — our reception team will contact you to confirm your appointment. For urgent medical matters, please call 012 023 4005 or the emergency line 082 629 8231.

New patient? Complete your Patient Information Form ahead of your visit to save time at reception. This form collects health information as described in our Privacy Policy.

Personal Details

Full Name *

ID / Passport Number *

Date of Birth *

Gender

Mobile Number *

Email *

Home Address *

Occupation / Employer

Medical Aid Details

Medical Aid Scheme

Membership Number

Main Member Name

Dependent Code

Next of Kin / Emergency Contact

Name *

Relationship *

Emergency Contact Number *

Medical History

Known Allergies

Current Medication

Chronic Conditions

Previous Surgeries

Relevant Family Medical History

Consent & Signature

I consent to Sampax Health 911 collecting and processing the health information provided in this form, as "special personal information" under section 32 of POPIA, for the purpose of opening and maintaining my patient file and providing me with medical care, in line with the Privacy Policy. I confirm that the information provided above is true and complete to the best of my knowledge.

Signed (type your full name) *

Date *

Prefer to complete this in person? Simply ask reception for a printed copy of the Patient Information Form on arrival at any of our 4 practices.

Name & Surname *

Mobile Number *

Your Email *

Nearest Practice

Subject *

Your Message

I consent to Sampax Health 911 using the information provided to respond to my enquiry, in line with the Privacy Policy.

Your message is sent directly to our practice team. For urgent medical matters, please call 012 023 4005 or the emergency line 082 629 8231.

Find Us

Our 4 Practice Locations

Tap a pin on the map or a card below for directions to your nearest Sampax Health 911 practice.

Practice

Brits

23 De Wits Laan, Spar Centre, Brits

Get Directions

Practice

Letlhabile

1517 Lusaka Street, Block B, Letlhabile

Get Directions

Practice

Ga-Rankuwa

8347 Kgomongwe Street, Zone 4, Ga-Rankuwa

Get Directions

Practice

Atteridgeville

74 Sekhu Street, Atteridgeville, Pretoria

Get Directions

Reach Out for Expert Healthcare

Call Us

Emergency 24/7

Email Us

WhatsApp

Book, Register or Ask a Question

Personal Details

Medical Aid Details

Next of Kin / Emergency Contact

Medical History

Consent & Signature

Our 4 Practice Locations

Brits

Letlhabile

Ga-Rankuwa

Atteridgeville