MEDICARE QUOTE REQUEST FORM

Your Name *

First

Last

Email *

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 time

Contact Number *

Where can we get in touch with you? Please add a landline- and/or a mobile number.

Your Company / Facility Name or -Details

Please choose the category that would apply to you best?

Private Hospital Group in South Africa
Distribution Company or Reseller
Another Medical End User, Clinic or Medical Practice
Emergency Medical Services
Educational-, Training- Universities or Schools
Other

Enter 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: *

Which 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.

MEDICARE QUOTE REQUEST FORM

KEMPTON PARK BRANCH

PRETORIA BRANCH

CAPE TOWN BRANCH

DURBAN BRANCH