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Booking Form

Booking Form

Booking Form

Kromboom Dental Centre charge medical aid rates. We however DO NOT deal directly with Medical Aids. Patients will need to settle their accounts first and claim back from their Medical Aid Provider.

Patient Status
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Name
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Field is required!
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Address
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PURPOSE OF DENTAL VISIT (you may select more than one choice)

Procedure

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Field is required!
Field is required!
Field is required!

PREFERRED DAYS AND TIMES OF APPOINTMENTS:

Office hours: Monday -Friday, 8:00 am - 8:00 pm (last appointment). Saturday 8 - 1pm (last appointment).
Please give several choices

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APPOINTMENT CONFIRMATION (Preferred method to receive your appointment confirmation)

Contact Method

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If you send this Patient Appointment Scheduler to us during the week between 9:00 am and 6:00 pm you will receive your confirmation by the end of the day. You will receive your appointment confirmation within 24 hours.
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