Practice signup

We assist companies with increasing your cash flow, reducing bad debt and freeing up time, so you can spend more time running your practice and generating turnover. Join our network of forward-thinking practices today!

To signup, simply complete the electronic signup form below. Alternatively, click here to download an application form for manual submission.

Once complete, you will be directed to a page where you can upload the required documentation. One of our consultants will then send you an electronic generated Service Level Agreement, as well as provide a marketing pack and training. If all required information is provided, your practice will have access to our network within 48 hours.

For any queries please send a mail to partners@colliermalan.co.za

Contact me

General Information

Legal Name

Trading name / Store name

Software Provider

Registration Number

VAT Number

Implementation Date

BHF Practice number (if applicable)

Practice Email Address

Practitioner ID number

Practitioner cell number

Number of Practitioners

Bank Details

Account Holder name

Account number

Branch Name

Branch Code

Bank Name

Address Details

Address

Postal Code

Province

I agree to the Collier & Malan terms & conditions