Request an appointment

Reception will respond within one working day to arrange your visit.

Your appointment is confirmed once reception has agreed a date, time and venue with you.

Initial consultation R2,450 · ultrasound included

Urgent symptoms? Please seek medical care rather than waiting for a form reply.

If you have severe pain, heavy bleeding, fainting, shortness of breath or feel acutely unwell, seek urgent medical care. Contact Life Kingsbury Hospital on 021 670 4000 or go directly to the emergency room. This form is not an emergency service.

Please check the highlighted fields below.

01 Your details

Name, date of birth, phone and email are required. All other details are optional; reception can help with these.

Full name (required)

Date of birth (required)

This helps reception match your patient record. Use DD/MM/YYYY, for example 14/02/1988.

Best phone number (required)

Best email address (required)

Have you seen Dr Jan Adlam before? (optional)

No, this is my first appointment Yes, I have seen Dr Jan Adlam before

Best way for reception to reach you (optional)

No preference Phone WhatsApp Email

02 Your appointment Optional

You do not need a diagnosis or a detailed explanation to request a visit.

Reason for your visit (optional)

You can discuss your concern with reception instead.

Where would you prefer to be seen? (optional)

Both locations are by appointment. Harbour Bay (Simon’s Town) is available on selected Mondays. Reception will confirm your venue, date and time. View locations.

Main concern or question (optional)

03 Timing & practical preferences Optional

Leave these blank for the next suitable appointment. A preferred date does not reserve a slot.

Preferred date (optional)

Leave this blank if the next suitable appointment is fine.

Preferred time of day (optional)

This just helps if mornings or afternoons are usually easier.

Anything practical we should know? (optional)

Please tell reception if you need a private or alternative way to receive messages.

Your request is stored on this website and emailed to reception to arrange your appointment. An automatic acknowledgement is sent to the email address you enter, even if you prefer contact by phone or WhatsApp; it does not repeat your appointment reason or notes. Keep optional notes brief. Reception may send a separate registration link after booking. Read our privacy notice, including advertising measurement, and how to make a privacy request.

We will respond within one working day. Reception will confirm your appointment with you.

HERE TO HELP

Speak to reception

If you would rather talk, or need help with this form, please get in touch.

Monday–Friday, 08:00–17:00
We respond within one working day. If you have not heard from us by then, please call or WhatsApp reception.

BEFORE YOUR VISIT

Consultation fees

Initial consultation: R2,450, including ultrasound.
Follow-up consultation: R1,150 for the same condition within 6 months of your last consultation. Ultrasound is included when needed.

Pay on the day by card or EFT; no cash. You submit the consultation account to your medical aid. Procedures, devices and laboratory tests have separate charges.

Fees & medical aid →

If plans change, please give at least 24 hours’ notice where possible. We understand that illness and emergencies happen.

Explore areas of care →Consulting locations →

WhatsApp reception