MEDICARE QUOTE REQUEST FORM Please enable JavaScript in your browser to complete this form.Your Name *FirstLastEmail *Where do we send your quote to?Would you like to subscribe to receive email updates on specials or events? *Yes please, sign me up!No thanks - I just want to receive a quote this one timeContact Number *Where can we get in touch with you? Please add a landline- and/or a mobile number.Your Company / Facility Name or -DetailsPlease choose the category that would apply to you best?Private Hospital Group in South AfricaDistribution Company or ResellerAnother Medical End User, Clinic or Medical PracticeEmergency Medical ServicesEducational-, Training- Universities or SchoolsOtherEnter your items you want us to quote you on here. Please include quantities or specifications, or any details we should be made aware of. * Please choose a Medicare Hospital Equipment branch near you: *Kempton Park BranchDurban BranchPretoria BranchCape Town BranchOwn Address will be added for deliveryWhich branch should quote you from where can you collect? We can add delivery to your quote as well if you wish. Please keep in mind some branches are admin branches only, and goods are often manufactured on order only. No walk-ins.Submit KEMPTON PARK BRANCH PRETORIA BRANCH CAPE TOWN BRANCH DURBAN BRANCH