Specialist Family Physicians in Private Practice

Thank you for taking the time to complete this form.

The SFPPP has entered into an agreement with Healthman to support our private practice physicians, to assist in obtaining optimal benefits of inter alia, rates and tariffs and other available resources.

Working towards obtaining an updated membership list with all the required members information; Practice telephone numbers, cell phone number, practice number, MP number, physical address etc. Also very important, whether you are in the public or private Sector or both

Your details might also be given to Healthman in order to verify your practice details with the BHF.

Members of this initiative need to contribute an additional R300.00 per month, excluding their normal membership fees.

Name and Surname *

PrefixFirst NameLast Name

Email*

example@example.com

Cellphone Number*

Format: (000) 000-0000.

Practice Phone Number*

Format: (000) 000-0000.

MP Number*

For validation purposes.

Practice Number*

For validation purposes.

Qualification*

MBChBFCFPOther

Type of sector*

PrivatePublicor Both

Province*

Select your province

1. Are you willing to provide SAAFP with more of your practice registration details?*

YesNoI'm not sure

2. Please keep me informed and send me emails about the forum.

YesNo

3. Are you currently a member of the SAAFP or SASOSFP*

SAAFPSASOSFPNO

We are trying to make contact with all the Private Family Physicians in South Africa in order to truly represent the specialist private practice sector.

If you know of any other Private Practice Family Physicians that would be interested in this initiative, please provide us with some of their contact details in order for us to get hold of them.

If you have any questions, please do not hesitate to contact us at admin@saafp.org.

Name

First NameLast Name

Email

example@example.com

Phone Number

Format: (000) 000-0000.

I hereby give consent that you can provide the details submitted above to Healthman.*

YesNo

Please verify that you are human*