• Preller Square | Dan Pienaar | Bloemfontein
  • Mon - Fri: 06:00 - 17:00

Online Admission

We Offer Professional, Affordable Medical Services to Private and Medical Aid Patients

Online Admission


In the Comfort of Your Home

Pre-Admission Service

Welcome to our online, pre-admission service. Our online pre-admission service allows you take care of this necessary administrative procedure in the comfort and convenience of your home or office. It also saves you time on the day of your visit.

Please have the following handy to register online:

  • Medical aid details and authorisation number
  • ID book
  • Doctor’s name

Download your fillable pdf form below.

In order for us to be able to process your application, please ensure that you complete and submit the form at least five (5) working days prior to admission.

Important Notice

Please provide all the information as requested. Our online pre-admission system will not register you unless all the information required is given.

Please Note

CityMed-What-to-BringForms have to be opened in Acrobat Reader in order to complete and submit the forms. Do NOT attempt to open them directly in your web browser, as you will then not be able to save and submit them.

To download a free copy of acrobat reader please click here.

Save Time in the Comfort of your Home

Download Pre-Admission Form

Click on one of the buttons to download the form. Open in Acrobat Reader,
complete the form, save and e-mail back to:

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