Make an appointment

Make an appointment

To request an appointment please fill in the following fields and click "Send".

Please note: All items preceded by a * are required and must be completed to submit this form. Furthermore you have to specify at least one telephone number.

* Title:
* First name:
* Surname:
* Please select city:
* Preferred consultation date:
Please provide your telephone number - The Headache Clinic will call to confirm that the booking time you have requested is available.
Home:
Work:
Cell:
* Email address:

Cape Town | Durban | Johannesburg

Tel: 0861 678 911 . . International +27 11 484 0933