Patient Forms

Operation Checklist

All the information you will need when you are booked for a procedure or operation

Mediclinic Kloof Hospital Pre-admission Form

You only complete this form when a date has been set for your operation or procedure. On completion of this form you need to forward it to the Hospital to book your bed and streamline the administrative proses

Little Company of Mary Hospital Pre-admission Form

You only complete this form when a date has been set for your operation or procedure. On completion of this form you need to forward it to the Hospital to book your bed and streamline the administrative proses

Complications of surgery / Discharge instructions

All the information you will need after being discharged from the hospital.

Operation Consent Form

This form needs to be signed to acknowledge that you are fully aware of what your surgery entrails and that you give Dr Van Niekerk permission to operate on you.

Patient Agreement

A standard contract between Dr Melt van Niekerk and his patients. You will also be asked to complete this page when visiting the practice for the first time

Medical History form

These forms must be completed by all new patients when they visit the practice for the first time