24 HR EMERGENCIES 082 782 4444 OR 021 782 4444

24-HR EMERGENCIES

082 782 4444

021 782 4444

OFFICE
021 782 0606

EMAIL

info@cmr-med.co.za

Online Application Form

Co-Members included

Monthly Membership Fees

  • Option 1: CMR Household Membership WITH Hospital Transport Cover: R360 per household per month (6 people max - see pricing below for additional people living on premises)
  • Option 2: CMR Household Membership WITHOUT Hospital Transport Cover: R255 per household per month (I understand the cost of ambulance transport to hospital will be billed separately if/when required)
  • Option 3: Pensioners' Household Membership WITH Hospital Transport Cover: R335 per household per month (max 2 people, at least one person must be 65 or above)
  • Option 4: Pensioners' Household Membership WITHOUT Hospital Transport Cover: R230 per household per month (I understand that the cost of ambulance transport to hospital will be billed separately if/when required)
SELECT ONE OF THE OPTIONS THAT WOULD SUIT YOUR NEEDS
Option 1Option 2Option 3Option 4
IF MORE THAN 6 PEOPLE NEED COVER AT THE PROPERTY INDICATE BELOW HOW MANY TO ADD AT AN ADDITIONAL COST OF R50.00 PER PERSON
Membership for Domestic workers who live off the property @ R66 p/person p/month
Please note mebership becomes active on receipt of this application. If you would like to activate the membership at a later date please indicate such date below
Person responsible for account
Cheque/CurrentSavings
Preferred debit date
1st of month15th of month

By submitting this form, I/we agree to subscribe to the service for two years in accordance with CMR's Standard Terms & Conditions which are available on request and on CMR's website: www.cmr-med.co.za I/we confirm that I/we have read and understood the terms and conditions and agree to the terms thereof.

I/we hereby authorize Cape Medical Response to debit my/our account with the total monthly premium indicated above, and in the starting month
indicated above. I/we understand that a charge of R120 will be levied for any debit-order non-payment/s.


Please note this form will only be sent if you have ticked the "I'm not a robot" box above AND clicked on the "submit" button below.
Should you not hear from us within 24 working hours something is not right - please call us on 021-7820606 or email mark@cmr-med.co.za