Application forms
Professional Boards are co-ordinating bodies for healthcare practitioners registered with the HPCSA. The respective boards that are established for a specific profession, deal with matters relating to a specific profession.
NB: Practitioners are advised to check for correct fees before making any payment
| Additional Qualification | |
|---|---|
| Form 19 - Additional Qualification | Download form |
| Form 19 - Emergency Care Board (EMB) | Download form |
| Form 19 - Medicine, Medical Science & Dentistry | Download form |
| Form 19 ODO - Recognition of Diagnostic Privileges -Optometry and Dispensing Opticians | Download form |
| Form 19 ODO - Recognition of Ocular Therapeutics | Download form |
| Application for registration | |
|---|---|
| Form 23 - Application for registration | Download form |
| Form 23 DOH - Dental Therapy and Oral Hygiene | Download form |
| Form 23 EMB - Emergency Care Board (EMB) | Download form |
| Form 23 MT - Medical Technologist | Download form |
| Form 23 MLS - Medical Laboratory Scientists | Download form |
| Form 23 ODO - Optometry and Dispensing Opticians | Download form |
| Form 23 - Independent Practice | Download form |
| Form 24 - Application for Registration | Download form |
| Form 24 DA - Aplication for registration as Dental Assistant | Download form |
| Form 24 EMB - Application for registration Emergency Care | Download form |
| Form 24 GT - Application for registration as Medical Technician | Download form |
| Form 24 KT - Clinical Technologist | Download form |
| Form 24 KT-G Clinical Technologist | Download form |
| Form 24 LA - Application for registration as Lab Assistant | Download form |
| Form 24 MT - Application for registration | Download form |
| Form 24 OH - Extended functions | Download form |
| Form 24 OS - Medical Orthotics and Prosthetics | Download form |
| Form 24 TT - Application for registration as Dental Therapist | Download form |
| Form 25 MTB - Intern duty certificate for Medical Technology | Download form |
| Form 27 OS - Intern Duty certificate - Medical Orthotics & Prosthetics | Dowload form |
| Form 27 OB/OSA - Intern duty certificate - Medical Orthotists & Prosthetics | Dowload form |
| Form 27 PSY - Intern duty Certficates for Psychologists | Download form |
| Form 176 EHP - Environmental Health Assistants | Download form |
| Community Service | |
|---|---|
| Form 10 A - Intern duty certificate for Completion of a 2 years Internship training programme | Download form |
| Form 14 A - Dentist (DP) to perform Community Service | Download form |
| Form 23 OT - Occupational Therapy, Medical Orthotics & Prosthetics & Arts Therapy | Download form |
| Form 23 - To perform Community Service | Download form |
| Form 27 - (Generic) Completion of Community Service | Download form |
| Form 23 - DOH | Download form |
| Foreign Qualification | |
|---|---|
| Form 165 - (Generic) Radiography and Clinical Technology | Download form |
| Form 176 AT - Registration as an Arts Therapist | Download form |
| Form 176 DT - Foreign Qualified Dietician | Download form |
| Form 176 EHP | Download form |
| Form 176 MDB - ECFMG | Download form |
| Form 176 NT | Download form |
| Form 176 ODO | Download form |
| Form 176 OT | Download form |
| Form 176 MT - Medical Technologists/ Bsc Graduates | Download form |
| Form 177 DR- Application for registration as Radiographer | Download form |
| Form 177 BKT - Application for registration as Clinical Technologist | Download form |
| Independent Registration | |
|---|---|
| Form 11 C - MDB | Download form |
| Form 23 OT - Occupational Therapy, Medical Orthotics & Prosthetics & Arts Therapy | Download form |
| Form 23 A (SLH) - Change of Category: Speech Language and Hearing Professions | Download form |
| Form 27 - Certificate of Completion of Community Service | Download form |
| Form 133 - Medical Technology (MT) Application to conduct private practice | Download form |
| Form 189 - Dental Therapist (TT) | Download form |
| Intern Registration | |
|---|---|
| Form 10A MDB - Intern in Medicine | Download form |
| Form 23 MSIN; PHIN and GCIN - Medical Biological Scientist, Medical Physicist and Genetic Counsellor only | Download form |
| Form 26 A - OS Placement of Intern | Download form |
| Form 26 BKIN - Biokineticist Intern | Download form |
| Form 26 MTIN - Intern Medical Technologist | Download form |
| Form 26 ATIN - Arts Therapy Intern in Drama | Download form |
| Form 26 A AT - Placement of Arts Therapy Intern in Drama | Download form |
| Form 27 AT - Arts Therapy Intern in Drama Duty Certificate | Download form |
| Form 27 BK - Biokineticist for Intern Duty Certificates | Download form |
| Form 36 GC - Certificate of Intern training (Genetic Counsellor) | Download form |
| Form 36 MS - Certificate of Intern training (Medical Biological Scientist) | Download form |
| Form 36 PH - Certificate of Intern training (Medical Physicist) | Download form |
| Restoration | |
|---|---|
| Form 18 - Application for restoration of name to the register | Download form |
| Form 18 PPB - Physiotherapy, Podiatry and Biokinetics only | Download form |
| Form 18 A - OCP - Occupational Therapy, Medical Orthotics & Prosthetics & Arts Therapy Application for restoration | Download form |
| Form 18 C - OCP - Occupational Therapy, Medical Orthotics & Prosthetics & Arts TherapyUndertaking by Supervisor | Download form |
| Form 18 D - OCP - Occupational Therapy, Medical Orthotics & Prosthetics & Arts Therapy Supervisory report | Download form |
| Form 18 F - OCP - Occupational Therapy, Medical Orthotics & Prosthetics & Arts TherapyPortfolio | Download form |
| Form 18 G - OCP - Occupational Therapy, Medical Orthotics & Prosthetics & Arts Therapy Portfolio marking guide | Download form |
| Specialties/ Sub-Specialties | |
|---|---|
| Form 9 - Application for registration as a Registrar / Sub-speciality Trainee | Download form |
| Form 21.1 MDB - Application for registration as a Specialist in terms of board notice 230 of 2015 | Download form |
| Form 57 A - MED Sub- Speciallity SA Qualified - Certificate relating to education and training in subspeciality | Download form |
| Form 57 MDB - Certificate relating to training in specialities & sub specialist | Download form |
| Form 57 MED - Certificate relating to training for specialists who commenced specialists training after 1 January 2011 | Download form |
| Students | |
|---|---|
| Form 8 - Visiting Student, in Supplementary Health Services | Download form |
| Form 8 - Visiting Student (Emergency Care) | Download form |
| Form 8 - Visiting Student (Medical and Dental) | Download form |
| Form 8 - Visiting Student (DNB) | Download form |
| Form 53 DA S- Student Dental Assistant | Download form |
| Form 53 EMB - Emergency Care Board | Download form |
| Form 53 DOH | Download form |
| Form 53 MDB and DOH - Student in Medical Science | Download form |
| Form 53 OT S - Re-registration after interruption of Studies- Occupational Therapist Student | Download form |
| Form 53 OTS - Occupational Therapist Student | Download form |
| Form 53 TT S - Dental Therapist Student | Download form |
| Form 53 TTS - Re-registration after interruption of Studies - Dental Therapist Student | Download form |
| Form 53 GTA/LAS | Download form |
| Medical & Dental | |
|---|---|
| Form 8 - Visiting Student | Download form |
| Form 11 A - Medical Practitioner Community Service | Download form |
| Form 19 - Additional Qualification | Download form |
| Form 21 MDB - Specialist/ Subspecialist SA Qualified | Download form |
| Form 23 MDB - Intern in Medicine SA Qualified | Download form |
| Form 24 GC - Application for registration as Genetic Counselor | |
| Form 24 MS - Application for registration as Medical Biological Scientist | |
| Form 24 PH - Application for registration as Medical Physicist | |
| Form 26 PHIN - Intern Medical Physicist | |
| Form 26 GCIN - Intern Genetic Counselor | |
| Form 26 MSIN - Intern Medical Biological Scientist | |
| Form 27 - Independent Practise | |
| Form 39 - Student Intern - Medical & Dental Professions Board | |
| Form 53 - Student | |
| Medical Technology | |
|---|---|
| Form 8 - Visiting Student | Download form |
| Form 19 - Additional Qualification | Download form |
| Form 23 - Community Service | Download form |
| Form 27 - Independent Practise | Download form |
| Form 53 - Student | Download form |
| Occupational Therapy, Medical Orthotics, Prosthetics & Arts Therapy | |
|---|---|
| Form 8 - Visiting Student | Download form |
| Form 19 - Additional Qualification | Download form |
| Form 23 - Community Service | Download form |
| Form 27 - Independent Practise | Download form |
| Form 53 - Student | Download form |
| Form 24 OTT - Occupational Therapy Technician (Supervised) | Download form |
| Form 26 OSIN - Medical Orthotist and Prosthetist | Download form |
| Optometry & Dispensing Opticians | |
|---|---|
| Form 8 - Visiting Student | Download form |
| Form 19 - Additional Qualification | Download form |
| Form 23 - Community Service | Download form |
| Form 27 - Independent Practise | Download form |
| Form 53 - Student | Download form |
| Physiotherapy, Podiatry and Biokinetics | |
|---|---|
| Form 8 - Visiting Student | Download form |
| Form 19 - Additional Qualification | Download form |
| Form 23 - Community Service | Download form |
| Form 27 - Independent Practise | Download form |
| Form 24 BK - Phyisiotherapy, Podiatry and Biokinetics | Download form |
| Form 53 BKS - Biokinteticist in Training | Download form |
| Form 53 - Student | Download form |
| Psychology | |
|---|---|
| Form 8 - Visiting Student | Download form |
| Form 19 - Additional Qualification | Download form |
| Form 23 - Community Service | Download form |
| Form 27 - Independent Practise | Download form |
| Form 24 PS - Registration as Psychologist | Download form |
| Form 24 PMT - Registration as Psychometrist | Download form |
| Form 24 RC - Registration as Registered Consellor | Download form |
| Form 26 PSIN - Intern Psychologist | Download form |
| Form 53 PSS - Psychology Student | Download form |
| Radiography & Clinical Technology | |
|---|---|
| Form 8 - Visiting Student | Download form |
| Form 19 - Additional Qualification | Download form |
| Form 23 - Community Service | Download form |
| Form 27 - Independent Practise | Download form |
| Form 53 - Student | Dowlnload form |
| Speech, Language and Hearing | |
|---|---|
| Form 19 - Additional Qualification | Download form |
| Form 23 - Community Service | Download form |
| Form 27 - Independent Practise | Download form |
| Form 53 - Student | Dowlnload form |
| Form 8 - Visiting Student | Download form |
| Other forms | |
|---|---|
| Application for Aproval of Mobile Practice - ODO | Download form |
| Contact details form - Change of Contact details | Download form |
| Practioners are advised to use the Prescribed Forms when Children are Involved | Download form |
| Form 2 Consent to social or cultural circumcision | Download form |
| Form 3 Consent to religious circumcision | Download form |
| Form 22 Reporting of abuse or deliberate neglect of child | Download form |
| Form 23 Reporting of abuse or deliberate neglect of a child to the Director General | Download form |
| Form 33 Application for Consent to Medical Treatent or Surgical Operation by Minister | Download form |
| Form 34 Consent to surgical operation by a child | Download form |