Canal Walk BookingSimon McCausland2023-07-27T14:31:52+02:00 Patient Information Canal Walk Canal Walk "*" indicates required fields Name* First Last Title* ID Number* Date of Birth* MM slash DD slash YYYY Cellphone Number* Email Address* Medical Aid Name If ApplicableMedical Aid Number If ApplicableFile UploadMax. file size: 512 MB.Please upload files or prescriptions here Select if booking for a dependant Click here to agree to the sending / receiving of electronic information relevant to the appointment CAPTCHA
