Practice sign-up

MediWallet is a human and veterinary linked product that effectively provides up to 18 months finance for your patients. Join our exciting network of forward-thinking medical practices today!

Signup process

Simply complete the electronic signup form below.
Alternatively, click here to download an application form for manual submission.

To get more information on MediWallet, email us at partners@mediwallet.co.za.

Once complete, you will be directed to a page where you can upload the required documentation. One of our consultants will then send you an electronic Service Level Agreement, as well as provide a marketing pack and training. If all required information is provided, your practice will have access to our network within 48 hours.

Does your practice need assistance in recovering bad debts?
We are partnered with Collier & Malan who can assist you with the recovery of outstanding debts on a no recovery - no fee basis by offering your practice a tailor-made debt collection solution that suits your business needs.

Find out more about the Collier & Malan debt collection services here.

Business Information ( is required)

Legal Name

Trading As

Registration Number

VAT Number

Practice Manager

Practice Email Address

Tel Number

Mobile Number

Website

Referred to MediWallet by

Bank Details ( is required) We require your bank details as we settle the practitioner directly and not the patient

Account number

Branch Name

Branch Code

Bank Name

Address Information ( is required)

Address

Postal Code

Province

Doctor/Director Information ( is required)

First Name	Surname	Email Address

Add Doctor/Director

I agree to the MediWallet Partner Terms & Conditions

Practice sign-up

Signup process

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