Ampath - Account Enquiries

Fill in the details below and book an appointment

*Is this appointment for:

*Your full name:

Patient’s full name (if appointment not for yourself):

*Patient’s date of birth:

*Email:

*Your contact number:

*Where do you live:

*Reason for appointment:

*Please provide the provisional diagnosis / main problem:

*Referring medical practitioner:

*Do you know if you need to see a genetic counsellor or a medical geneticist:

*Would you prefer an in person or virtual appointment (Online appointments are not possible when the patient requires a clinical examination):

Any additional comments or questions: