Financial Responsibility Agreement

This Financial Responsibility Agreement ("Agreement") sets out the consultation fees and payment terms for appointments with Dr GM Monama, Specialist Otorhinolaryngologist & Surgeon ("the Practice"). By checking the consent box on the booking form, you acknowledge that you have read, understood, and accepted these terms.

1. Consultation Fees

• R1,200 — standard consultation fee for patients paying cash or by card.
• R600 — consultation fee for patients using a valid, active medical aid.

Fees for surgical procedures, hospital admissions, and additional investigations (imaging, laboratory tests, etc.) are billed separately and are not covered by this Agreement.

2. Medical Aid Patients

Patients using medical aid remain personally liable for any shortfall, co-payment, or amount not settled by their scheme, including amounts arising from the scheme's tariff, benefit limits, or late/declined claims. Please confirm your scheme's benefits and any co-payment obligations with your medical aid before your appointment.

3. No-Show Policy

Patients who fail to attend a confirmed appointment without prior notice ("no-show") will be charged the full consultation fee applicable to their payment method (R1,200 cash / R600 medical aid).

4. Cancellation Policy

To avoid a no-show charge, appointments must be cancelled or rescheduled at least 24 hours before the scheduled appointment time. Cancellations made less than 24 hours before the appointment will be treated as a no-show and charged accordingly.

5. Payment

Payment is due at the time of consultation unless alternative arrangements have been agreed with the Practice in advance. The Practice accepts cash, card, and direct medical aid billing where applicable.

6. Changes to This Agreement

The Practice may update consultation fees and these terms from time to time. The fees and terms in effect at the time of your appointment will apply.

7. Contact

Questions about fees or billing can be directed to the Practice at legal-tech@drglenmonama.com.