Get Thebemed Application Form

The Thebemed Application Form is a vital document for individuals seeking to apply for medical aid coverage. This guide provides clear instructions on how to accurately complete the form online, ensuring a straightforward application process.

Follow the steps to fill out the Thebemed Application Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the principal member details. Enter the title, membership number, initials, ID number, surname, and first names in the designated fields.
3. Proceed to patient information. Fill in the title, initials, surname, first names, date of birth, gender, and ID number. Also, provide the postal address and telephone numbers, ensuring to include a valid email address.
4. In the vital data section, input height, weight, blood pressure, and indicate any allergies. Be sure to specify your smoking and alcohol consumption habits.
5. Attach any relevant pathology results or reports that may expedite the application process.
6. Indicate the diagnoses by checking the relevant conditions that apply, or specify any other medical conditions if necessary.
7. Fill out the doctor's details, including surname, initials, practice number, and contact information. Ensure that the doctor's signature and diagnosis are included.
8. Review the declaration section, provide your signature, and date to confirm consent for information disclosure.
9. Lastly, complete the delivery address section with the doctor's address, member address, or any other specified delivery address.
10. Once all fields are completed, save the changes, download, print, or share the form as needed.

Take the next step in managing your health by completing your application online.