+27 72 682 0900

info@abovax.com

If you are ready to make an enquiry to ABX Health International Care, please fill in the form below. Please include as much information as possible about your condition, medical history and the reason for your enquiry. We won't share your contact information with anyone outside of the ABX Health/Abovax Group.

Form A:



1. Type of enquiry (required)

If you selected 'other' please provide further information



2. Personal Information

Title

Email (required) Phone Number (required)


Date of Birth (required)

Nationality



3. Area of speciality and treatment required

Select Speciality

Select Treatment

To be completed if you have answered 'Yes' to the above



4. Health Provider Information

Do you currently have a local treating or referring doctor?

Yes No

If yes, please provide the full names, registration and contact details of your health provider or practice/company below


5. Payment information

Payer (required)



6. Confirmation

I confirm that I have provided all the information required to facilitate he processing of my inquiry. I hereby authorize ABX Health to contact me in relation to this request by way of email, phone, or any other communication channel deemed to be suited.