Virtual Consultation Registration

Legal Name*

First NameLast Name

Date of birth*

Date

Gender*

MaleFemaleOtherPrefer not to say

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Reason for enquiry*

Please provide any details below

Your contact preference*

EmailWhatsApp

My Products

SWIFT Virtual Consultation Product Image

SWIFT Virtual ConsultationVirtual Consultation Your session takes place online in a private, secure environment. The consultation is strictly 45 minutes and focuses on a structured assessment of your symptoms, medical history, emotional context, and relationship factors. This is not an open-ended discussion. It is a focused clinical interview designed to identify the drivers of your concern and outline a clear management plan. You receive guidance on next steps, required tests, and the boundaries of what can be managed virtually. All information is confidential, and follow-up is arranged when clinically appropriate.

$50.00

SWIFT Package 3 SessionsThree-Session Package Some concerns need more time and structured follow-through. The three-session package gives you a planned series of virtual consultations, each 45 minutes, scheduled over several weeks. Session 1 focuses on assessment. We define the problem, review medical and emotional factors, and set your goals. Session 2 reviews progress, unpacks deeper contributors such as stress, trauma history, or relationship strain, and adjusts the plan based on your response. Session 3 consolidates the work. We finalize your management plan, outline long-term strategies, and decide on any further tests, referrals, or digital tools you may need. This package is designed for women with chronic symptoms, longstanding relationship difficulties, trauma-linked sexual problems, or mixed medical-behavioural issues that cannot be addressed in a single session. Each consultation is confidential and follows a clear structure to ensure clinical quality and realistic outcomes.

$135.00 Quantity

Total

$0.00

Type a question*

Consent to Treat: I consent to receive medical evaluation and treatment from Dr H P Manyonga PracticeTelehealth Consent: I understand that this consultation is a virtual (telehealth) visit and has limitations compared to an in-person exam. I understand the risks, benefits, and alternatives to telehealth.Notice of Privacy Practices: I acknowledge that I have read the Dr H P Manyonga Practice Privacy Practices as stipulated by POPIA.

Address (for determining your nearest provider in case of referral to local care)*

Street Address

Street Address Line 2

City/TownProvince

Post CodeCountry

Appointment

Signature*

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Patient Registration