Umhlanga Eye InstituteUmhlanga Eye Institute

Pre-Admission Form

Please fill in your details in the form below in order that we may streamline our admission process.

Fields marked with a * are required. Once submitted, please also email a copy of your Medical Aid Card to

  • listed alphabetically
  • if applicable

Print Form

Prefer to download and print this form?

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Complete your details and send it through to our reception on:

Fax: 031 536 1802