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Medical Enquiry Form

If you have decided that you would be interested in coming to South Africa for a medical procedure please complete the questionaire form below which will allow Jamandi to respond with detailed information for you to consider.

Personal Information


Medical Information

High Blood Pressure
Heart Disease
Known Immune Disease
Known allergy to local or general anaesthetics
None of the Above

Please select an option

Pregnant
Trying to fall pregnant
Breastfeeding
None of the Above

Please select an option

Please indicate available/ preferred dates for procedure or surgery:*


Dental Procedures

Teeth Whitening
Dental Implants
Porcelain, Veneers, Crown or Bridgework
Other.


Ophthalmic Procedures

Cataract Surgery
Retinal Repair
Corneal Transplantation
Strabismus Repair
Glaucoma Surgery
Eye Laser Procedures
Other


Plastic & Reconstructive Procedures or Surgeries

Liposuction
Please Specify area

Rhytidectomy/ Face Lift Mini or Full
Blepharoplasty/ Eyelid Lower or Upper
Rhinoplasty/ Nose
Otoplasty/ Ear Setback
Botox, Restylane, Perlane

Breast Reduction
Breast Augmentation
Mastopexy/ Breast Lift
Abdominoplasty/ Tummy Tuck


Vein Removal:

Sclerotherapy
Vein Stripping or Removal
Radio Frequency Ablation and Laser

Obstetrics & Gynaecology

Fertility Treatment
Midwife & Doula
Cryosurgery
Hysterectomy or Sterilisation
Pap Smear & Cervical Screening
Elective Caesarean Section

General Surgery:

Hernia Repair
Removal of Tumor
Galbladder

Cardiac Surgery:

Bypass Surgery
Stent Procedure
Angioplasty

Paediatric Surgery(children):

I need a Paediatric Surgeon.

Dermatology:

Mole Check
Sun Damage/ Skin Damage


Orthopaedic Surgery

Replacement
Arthroscopy
Revision
Correction of a fractured Hip, Limb or Joint

Removal of Ganglion, Bunions, Ingrowing Toenails, etc.
Carpal Tunnel Syndrome
Fractures
Hammertoe


Yearly Medical Check

This includes: Resting & Stress ECG, Chest X Rays, Lung Function Test, Eye & Hearing Screening, Blood Test for Cholesterol, Full Blood Count, Urea & Electrolytes, Liver function, Thyroid Function, Uric Acid, Fasting Glucose, Prostate, Pap Smear etc. Thorough Examination by a General Practitioner(Doctor). A medical History File to take home. (Mammogram and Bone Density can be arranged)