0861 000 266
info@highcareems.co.za
137 Bellefield, Avenue, Mondeor, 2091
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Home
Find A Branch
Careers
Services
Gallery
Contact Us
Visit our location
137 Bellefield, Avenue, Mondeor, 2091
Send us mail
info@highcareems.co.za
Phone Number
0861 000 266
GET A QUOTE
Patient Transportation Quotation
Patient Transportation Quotation
Quotation
Quotation
Patient
Transportation Quotation
Patient Transportation Quotation Request Form
Medical Aid Transfer or Cash Transfer
Medical Aid Transfer
Cash Transfer
Cash Transfer Transport details
Patient details
Patient Name
Date Of Birth
ID Number
Age
Phone & Cell Number
Residential Address
Transport details
Pick Up Date
Pick Up Address
Pick Up Time
Hospital Adress/ Drop Off Adress
Referring Doctor Name & Surname
Contact Number
Email
Receiving Doctors Name & Surname
Contact Number
Email
Patients Diagnosis
Patients Medical History
Reason For Transfer
Patients Priority Level
P1
P2
P3
Upload Medical Transfer Letter
Upload Medical Transfer Letter
Medical AID Details
Medical Aid Name
Medical Aid Number
Medical Aid Plan
Auth Number
Auth Given By
Patient details
Patient Name
Date Of Birth
ID Number
Age
Phone & Cell Number
Residential Address
Medical Aid Main Member Details
Members Name & Surname
ID Number
Work & Cell Number
Work Address
Residential Address
Transport details
Pick Up Date
Pick Up Address
Pick Up Time
Hospital Adress/ Drop Off Adress
Referring Doctor Name & Surname
Contact Number
Email
Receiving Doctors Name & Surname
Contact Number
Email
Patients Diagnosis
Patients Medical History
Submit Form
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