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Dieticians PPD application list

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 www.dieteticservices.co.za has an option for members of the public to
“Request a Dietician” We receive up to 6 queries / requests for dieticians per working day.

Please fill in this PPD APPLICATION FORM to be listed on Dietetic Services printed list. For Private Practicing Dieticians only.

Dieticians are required for:
   - PPD / food development / food labeling / Food service management

This "PPD List" is not given to OR shared with anyone.

  • There is NO cost to you or the "patient"

  • Please e-mail us if you stop practicing.

  • Please resend / re-request this form when your details change.

  • Your telephone / cell number & exact practice address will be given to potential patients.

Information Required

  		 
Professional Details  
DT / HPCSA Registration Number:
Surname
Maiden Name
Preferred First Name
University where you attained
your dietetics degree
 
  		 
Practice Details  
Telephone number
Cell number
E-mail address
Physical Address of Practice:
      Town / City
      Suburb
      Exact Street Address
        - the nearest corner street
        - the street number
        - type, colour & height of building
All/ Other large suburbs near your practice:
 
  		 
Extra Information  
Year when you started your dietetic practice
Any Children ?
Your strengths (likes?) Patients you prefer to treat eg ,diabetic , cholestrol ,  children.........etc
The type of work you do NOT really want.  eg Pregnancy, anorexia , allergies , "weight loss", terminally ill
Other areas of expertise, eg food labeling, consultancy to the food industry
Other comments
Type this code in the box below xYz345
 

Please e-mail or fax this form to us:   E-mail: scharf@icon.co.za     Fax: 086 512 0511

DIETETIC SERVICES
Oskar Scharf BA(WITS), CERT ELECT LIGHT (WITSTECH)
Cell 082 212 0324   Fax 086 512 0511 (South Africa only)
FOR A DIETICIAN: ONLINE FORM or EMAIL
5 Swazi Road, Boskruin, Randburg
PO Box 462, Bromhof, 2154, South Africa