Book Now - Doctors on Location Africa

1) Use the form provided to send us information about the services you require. The form will only take a few moments.

2) We will then contact you to confirm your booking.

3) Once confirmed, you will make your electronic payment with the link provided.

4) See you on location!

First name*

Last name*

Birthdate

Phone*

Email*

Physical Address*

Select the type of service you require*

I am making private booking for myself or a small group

I am making a booking on behalf of an event/production company requiring a group consult

Reason for Consult

Basic main complaint

Estimated Number of Patients to be Seen

Name of Event/Film Production Company

Event/Film Set Details

Please provide a brief description of the event/film set where our services will be required.

Date of Requested Consult*

Time of Requested Consult*

Please indicate whether you require a single/multi day booking*

Services will be required for one day only

Services will be required over several days

From Date*

To Date

From Time*

from time on first day

To Time*

to time on final day

Please indicate whether services will be required for a full day or one hour only*

Full day

One hour only

One Day Only Start Time*

One Day Only End Time*

One Hour Consult Start Time*

Patient Alleries

Patient Chronic Illnesses

Event/Film Set Services Required

Medical Consulting

Covid-19 Testing

Procedures (as medically indicated) : E.g. IV infusion

Medical Supervision/Standby

Advising/Professional Supervision for Portraying Medical Scenarios on Screen

Teleconsultation

Private Services Required

Teleconsultation

Any Additional Comments

Consent*

No Yes

I give my consent for an on-location medical consult and required medical treatment/teleconsultation from Doctors on Location Africa.

Patient/Organizer Full Name*

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