Provider Portal - Forms

View the benefits, health management programmes and chronic conditions covered by your patient’s medical scheme and option.

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*Health4Me is an insurance product, not a medical scheme.

Patient forms
Chronic benefit registration	Application form
HIV benefit registration	Application form
PEP (Post-Exposure Prophylaxis) registration	Application form
Health4Me network GP patient education pad	English Afrikaans Sesotho isiZulu
Dental consent form (Silver and Gold Option)	Dental consent form Waiting period may apply.
Specialist referral	Specialist referral form
Radiology request	Radiology request form
Pathology request	Pathology request form

Resources for you and your patient