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Application forms

Editable application forms are now available for you to complete digitally. You can navigate through the form by pressing the down arrow. If you can't physically sign a form, you must sign it digitally. We accept digital signatures from these digital signature providers:

  • SigniFlow
  • DocuSign
  • Quickly Sign
  • Hellosign
  • Santamflow
  • Smart Advice signatures
  • Adobe Sign with certificate

Applying to become a member of Remedi (with underwriting)

Applying to become a member of Remedi (without underwriting)

Application to add dependant

Application to register an additional adult dependant

Application for additional services during an in-hospital admission for depression

Application for registration of newborn baby

Advanced Illness Benefit application form

Application for claims incurred outside of South Africa

Application for special payments made from the PMSA

Application for out of hospital management of a PMB condition

Application for additional out-of-hospital treatment over and above that provided by the Prescribed Minimum Benefits

Bariatric surgery application form

Chronic Illness Benefit application form

Consent form to allow disclosure of information to a third party

Continuation form

Disputes Form (Application to investigate a Dispute-Complaint)

Exgratia application form

Health Declaration form

HIVCare Programme application form

Member withdrawal application form

Option change form

Permission to change banking details

Pre-assessment request

Request for additional cover for PMB Chronic Disease List application form

Request for additional cover from the HIV Prescribed Minimum Benefits Baskets of care

Request to reverse the payment of a claim that Remedi received and paid

Transfer from active member to retiree status

Request for an extended supply of medicine

Request for pre exposure prophylaxis

Request for treatment of a maintenance or physical nature

Settlement agreement for an amount owing to Remedi Medical Aid Scheme

Standard Option patient liability form

Remedi Standard Option Pathology request form

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