Service Terms & Conditions
Terms and Conditions
(Incorporating Acknowledgement of Medical Services and Guarantee)
I, the undersigned, hereby:
(i) consent to the medical services to be rendered to myself and, to the extent I am not the patient, the patient, as his or her guardian and/or as guarantor;
(ii) agree to the terms, conditions and provisions herein set out; and
(iii) acknowledge, having read and understood the terms, conditions and provisions herein contained, that, upon acceptance hereof by S Holt Incorporated (“SHI”), a legally binding and enforceable agreement will come into being by and between us.
SHI is dedicated to providing an efficient and effective service to its patients and to this extent if I, as patient, guardian and/or guarantor, as the case may be,:
– feel that this is not the case, I am free to contact SHI on its info email address (firstname.lastname@example.org) to register my satisfaction or dissatisfaction with the service; and/or
– wish to register a complaint against any member of the SHI practice or supporting doctors for ethical or professional reasons, I can do so by contacting the Health Professions Council of South Africa (Tel no. 012 338 9300).
I accept that it is my responsibility to ensure that I understand the approximate and indicative costs involved in the care or treatment I am to receive and be responsible for the payment thereof. If I do not understand and/or am uncertain as to the fees and costs to be charged by SHI, as set out on the signage and/or notice boards explaining the fees and cost structures and/or any individual fee or cost, I must prior to proceeding with the services and/or goods, consult with the SHI nurse on duty in this regard, failing which I will be deemed to have (i) fully understood and accepted such fees and costs; and (ii)signalled to SHI my understanding and acceptance thereof, upon which SHI can rely.
By my signature hereto, I confirm that:
- I and/or the patient, as the case may be, will and have/has received the services and/or goods contemplated and provided for herein; and
- I am and will be liable for any account rendered by SHI in respect of such services and/or goods; and
- I understand and accept that SHI will not necessarily charge its fees or costs in terms of and/or in accordance with any coding system and/or medical scheme tariff and, as such, to the extent SHI’s fees and costs invoiced to me for its services and/or goods exceed any amount claimable from my medical scheme and/or employer regulated body, I will be responsible for the payment of such excess amount, being the difference between my invoiced amount and the amount actually paid by my medical scheme or employer regulated body; and
- I accept that I will, at all times, remain liable for the full account with SHI in my personal capacity, as principal debtor and/or guarantor, as the case may be, to timeously pay any amount due to SHI; and
- if I have signed on behalf of the patient, I do so as guarantor and co-principal debtor, hereby irrevocably and unconditionally guaranteeing, as a primary obligation, in favour of SHI, the due and punctual performance and payment, against receipt of invoice of the account, hereby: (i) accepting that all admissions of indebtedness by the patient will be binding on me; and (ii) waiving my right to first require SHI to demand payment from the patient and/or the medical aid or any other third party; and (iii) renouncing all and/or any of the legal benefits and exceptions no cause of debt (non causa debiti), no value received (non numeratae pecuniae), simultaneous citation and division of debt (de duobus vel pluribus reis debendi), error in calculation (errore calculi) and revision of accounts, insofar as they or any of them may be applicable, the meaning and effect of such benefits and the renunciation thereof I am fully aware of; and
- SHI will not be liable, directly or indirectly, for any loss, damages, costs and/or expenses directly or indirectly sustained by myself and/or the patient as a result of the services so rendered and that I/the patient hold SHI harmless against all and/or any damages and/or losses incurred by me/the patient as a consequence of any claim arising from the services so rendered, hereby waiving all such claims against SHI; and
- I will be responsible for the payment of all costs and expenses incurred by SHI in the event I fail, neglect, refuse or be unable to pay, in whole or in part, any amount due to SHI and my account is, for any reason whatsoever, handed over to a debt collector or attorney to collect same, which costs will include all and any costs, fees, and/or disbursements, whether they be tracing costs, debt collectors fees and commissions, as well as attorney’s fees on the scale as between an attorney and his own client; and
- SHI is and will be entitled to:
- Charge interest at the prevailing mora interest rate from time to time, on my outstanding account from the due date thereof until payment in full thereof; and/or
- Have me listed with a credit bureau in terms of Regulation 19(4) of the National Credit Act, 2005 (Act No.34 of 2005), as amended, the consequences of which I am fully aware; and/or
- Institute any legal action or proceedings against me in the Magistrates’ Court having jurisdiction in accordance with the Magistrates’ Courts Act 1944 (Act No.32 of 1944) , as amended; and
- a certificate signed by an authorized representative of SHI, whose appointment and authority it need not be necessary to prove, as to the amount owing by me, at any time, the fact that such amount is due and payable, the rate of interest payable thereon and the date from which such interest is reckoned, shall be binding on me and prima facie proof of the facts stated therein and may be used as a liquid document in any competent court for purposes of obtaining summary judgement and/or provisional sentence; and
- I choose, as stipulated on the admission form and/or sticker, as my service address all and/or any of the physical address, email address, fax number and/or cell number (for SMS or short message service), whichever medium SHI may elect, to receive any correspondence, invoices, statement, notices, letters of demand and all other legal or court papers and documents from SHI and specifically authorise and direct that SHI not be required to deliver same by registered or other post, notwithstanding any legal requirement prescribed therefore; and
- insofar as any of the provisions contained herein are in conflict with any of the laws of South Africa, including but not limited to the Consumer Protection Act, 2008 (Act No.68 of 2008), as amended, for the time being in force, such provisions will be deemed to be amended only to the extent necessary to comply with the provisions of such laws.
By my signature hereto, I authorise my and the patient’s medical information may be shared with:
- my medical scheme and/or insurers for the purposes of receiving the payment contemplated herein; and
- SHI’s medical colleagues involved in the treatment of my and/or the patient as contemplated herein; and
- the administration division of SHI for the purposes of submitting and receiving and remitting payments
- the administration division of SHI for the purposes of receiving information pertaining to services offered by SHI
- a hospital group for the purposes of current or future admission.
I consent to receiving marketing information from the practice and its partner companies
I confirm having read and understood this agreement and accept the terms and conditions thereof.