Doctors Network Application Form

Day1 Health Doctor Online Application Form

1Doctor Health wishes to identify any willing and able providers to render quality and cost-effective services as non-exclusive designated service providers on behalf of all our clients to members on the 1Doctor Health Options.

Practice Details

Do you require us to install Synaxon in your practice (at no cost)?
Are you a Scripting Practice?
Are you a Dispensing Practice?

Physical Address

  • - select an option -
  • Eastern Cape
  • Free State
  • Gauteng
  • KwaZulu-Natal
  • Mpumalanga
  • North West
  • Northern Cape
  • Western Cape

Postal Address

  • - select an option -
  • Eastern Cape
  • Free State
  • Gauteng
  • KwaZulu-Natal
  • Limpopo
  • Mpumalanga
  • North West
  • Northern Cape
  • Western Cape

Practice Contact Details

Banking Details

Supporting Documents

Cancelled Cheque Or Stamped Bank Letter
Proof of Practice physical address
BHF Registration Confirmation
ID Document
HPCSA Registration Confirmation
License to Dispense

Create your account

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