Find us Here

Suite 2019
1st Floor, North Wing
Alexandra Road, Pinelands
7405

Landline

021 685 2635

Mobile

061 521 4060

Email

info@drimthiazhoosen.co.za

Forms

Please download, complete, and upload the following files along with the new patient registration form below. 

New Patient Info Form
Liability Letter
Data Consent
Proforma
PHQ 9 Form

New Patient Registration

To register as a new patient, please fill out the form below. Additionally, you will need to download, complete, and submit the supplementary forms along with your electronic submission.