Patient Portal Need Help? E-mail: sales@oxy-gen.co.za Patient Portal PATIENT INFORMATION Name Name First First Last Last Patient Contact Number * Alternative Contact Number * Email * Branch GautengPolokwaneKwa-Zulu NatalEastern CapeCape TownBloemfonteinMpumalanga Case Manager Account Number Equipment to be Rented * Referring Doctor Delivery Fee Method of Payment * CashEFTCardMedical Aid PATIENT DOCUMENTS Patient ID Click to upload Choose File Maximum file size: 2MB Proof of Residence Click to upload Choose File Maximum file size: 2MB Medical Aid - Card / Confirmation Click to upload Choose File Maximum file size: 2MB NEXT OF KIN DOCUMENTS Copy of ID Click to upload Choose File Maximum file size: 2MB Proof of Address Click to upload Choose File Maximum file size: 2MB Script Upload Drop a file here or click to upload Choose File Maximum file size: 2MB Additional Information These documents have been uploaded by the Case Manager. Captcha If you are human, leave this field blank. Submit
