Please note:
• Services that are rendered are payable prior to or on the same day as services rendered.
• Dr J.P.S Grové Incorporated charges private fees and may be higher than NHRP and HPCSA tariffs.
• I accept that unpaid accounts will be handed over for collection, I shall be liable for all attorneys and own client fees, collection charges, debt recovery charges and all disbursements. I agree to inspection of and negative listing of my credit information should my account remain outstanding.
• I hereby agree that notwithstanding the provisions of The Law of the Protection of Personal Information Act, No 4 of 2013, all relevant medical and personal information and photographs concerning myself, which may be deemed reasonable and of necessity may be provided to third party suppliers for the purpose for which it is required.
• I hereby choose as my domicillium et executandi for all notices and the services of all processes the above address.
• I hereby agree to receive marketing material and a monthly newsletter from 1,2 Smile.
• We do not spam. Your email address is safe with us – we keep our patients updated on specials with a monthly newsletter. You can unsubscribe at any time.
