Medical Information - submission
The Event Medical Officer requires confidential from you .
This medical information will be kept private and only accessed by the Medical Officer
You MUST submit the information via this form.
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Email *
Full Name *
Emergency Contact person *
Emergency Contact number *
Medical Aid Name *
If not on Medical Aid please specify  that this is the case
Medical Aid Number *
Medical Aid Principal Member Name *
Medical Conditions to be aware of *
If NONE please indicate "None"
Medicines currently being used *
Allergies *
Your contact number *
Should we need to follow-up to obtain more details
Submit
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