Aspigon 209 T/A Antonet Brand

Patient Registration

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Personal Details

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Informed Consent

Treatment Consent

I, the undersigned patient (or authorised representative), hereby consent to wound care assessment and treatment by Antonet Brand, Private Nurse Practitioner, trading as Aspigon 209 (Practice No. 0998354).

Scope of Services

I understand that services provided include wound assessment, dressing changes, wound debridement where clinically indicated, and related nursing care. Treatment is conducted at my home or agreed location.

Photography Consent

I consent to clinical photographs being taken of my wound(s) solely for the purpose of monitoring healing progress and maintaining clinical records. Photos are stored securely and will not be shared beyond my direct care team without my written permission.

Payment & Medical Aid

I acknowledge and agree that Aspigon 209 T/A Antonet Brand does not submit claims directly to any medical aid scheme. All fees are payable in full by me on receipt of invoice or immediately after each consultation/treatment session. It is my sole responsibility to submit claims to my medical aid for reimbursement.

I understand that on request, the practice will supply all required supporting documentation for my medical aid claim, including clinical motivation letters, treatment summaries, and assessment reports.

Cancellation

I agree to provide at least 24 hours' notice for cancellation or rescheduling of appointments. Late cancellations or no-shows may be subject to a call-out fee.

Confidentiality

My personal and clinical information is held in confidence in accordance with the Protection of Personal Information Act (POPIA) and applicable health legislation. Information will not be disclosed to third parties without my consent except where required by law.

Voluntary Consent

I confirm that I have read and understood this consent, that I am providing consent voluntarily, and that I have had the opportunity to ask questions before signing.

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