POPIA Consent Form

POPIA Consent Form

  • I, hereby consent to the processing of my personal information contemplated in the Protection of Personal Information Act No 4 of 2013, by Dr Johann Lochner, the practice staff and third parties with whom Dr Johann Lochner has a contractual relationship (eg Accountant and Auditor) for the following purposes:

    1. Treating and managing me in terms of a doctor-and-patient relationship;
    2. The administration of the contractual relationship between myself and Dr Johann Lochner;
    3. Communicating with third parties who have undertaken to indemnify me for the costs of my treatment and management or part thereof including medical schemes and their administrators where relevant; and;
    4. Collecting monies outstanding from me.
  • MM slash DD slash YYYY

Important COVID-19 InformationRead More