We'll need your basic details so that we can contact you when necessary, pre-fill all your medical forms (if requested), and so that we know who you are when you call our call centre.

Note that you'll have to complete this form all at once and we would recommend doing so on a computer, rather than on your phone.

Please fill out your medical details to the best of your ability. This information will empower the Infinity Medical Concierge call centre to help you as quickly as possible, and will be used for your Infinity Medical Concierge Health Plan.

We'll need your medical aid details so that we can provide this information to healthcare professionals who may require it when booking appointments. This may also be necessary in a medical emergency.

Please choose your preferred method of payment, and enter your invoicing details.

Should you wish to pay via debit order, a debit order form is available for download below.

As a new Member of Infinity Medical Concierge, you will be receiving a special Welcome Gift which may help you put your feet up and de-stress after a busy day. Please provide the information on this screen so that this bespoke gift can be ordered for you.

In order to proceed with your onboarding, you'll need to accept the Infinity Medical Concierge Terms & Conditions.

Please contact Infinity Medical Concierge if you have any questions regarding these terms.