13 December 2011
SPECIAL - SPECIAL -Back by POPULAR demand!!! Only R499 for a Full Body Scrub, Wrap and Massage! Book now to avoid dissapointment! Valid until 30 December

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Aesthetic Medical Training Registration:

Register online for the next aesthetic medical training course. Simply fill out the form below and click send. We will then contact you to complete the registration process.

Due to the nature of BOTOX® being a schedule 4 medicine the following documentation is compulsory as required by law and is to be submitted with this registration form by fax to +27 21 438 7908.

  • Copy of cancelled prescription
  • Copy of HPCSA card
  • Copy of Identity Document

All fields are required.

Personal Details
First Name:
Last Name:
ID Number:
Employer / Trading Name:
MP / DP Registration Number:
Practice Number:
Physical / Practice Address:
Postal Address:

Contact Details
Work Land Line:
Work Fax:
Home Land Line:
Mobile:
Email Address:

Training Workshop

Please select your prefered training workshop location:

Workshop Location:

Training Modules & Dates
Please select a Workshop location in order to view the available training modules and dates.

Payment Details
Payment Type:

Terms & Conditions
You have read and agree to the Terms and Conditions of this online form

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