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Patient form

Please download and complete the patient information form before your appointment and surgery consent forms if applicable. 

 

Email the form back to admin@entlong.co.za or print, complete and bring with you to your appointment.

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If you have any problems please call us on 021 531 4282 or email us at admin@entlong.co.za or look at our FAQ page.

Dr Michele Long

Our Address

Room 128,

Vincent Pallotti Life Hospital
Pinelands, Cape Town

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Tel:  021 531 4282

or 086 580 5544 after hours

​Email:  admin@entlong.co.za

Rooms open

Monday to Friday

8am - 5pm
By Appointment Only

Contact Us

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