patient

sign up

the benefits of joining

Receiving up to date information on the rare disease and congenital disorder landscape in South Africa, and globally.
Support and assistance to see you throughout your patient journey
Peer-to-peer support (connect with others with the same / similar conditions)
Ability to join our closed Facebook group, ask questions and connect
Access to educational support
Access to counselling and emotional support
Improved awareness

Helps us improve the data on prevalence and incidence of various rare diseases and congenital disorders
We get to raise awareness and share community stories to educate the public on RDs and CDs
We get a better understanding of what our community needs

how you joining helps us at RDSA

costs for
patient membership

No membership fees, donations are welcome.
Should you wish to contribute, please email with your invoicing details for us to arrange accordingly. All donations are tax-deductible in accordance with Section 18A of the Income Tax Act.

register today as a patient with RDSA and join our rare community

patient registration form

Patient's First Name

Patient's Last Name

Patient's Email

Patient's Contact Number

Patient's Physical Address

Patient's Birthday

What are your reasons for registering with Rare Diseases South Africa?

To connect with other patients with my condition

To learn more about my disease

To share my story

To get involved with the Rare Disease Community

To get access to rare disease treatments

For referral to appropriate treatment facility

To be assisted with regards to getting tested and obtaining a diagnosis

To connect with a disease specific group

What is the patient's Medical Diagnosis?

What are the patient's symptoms?

Are you a member of a dedicated support group?

Yes

No

No, but would like to be

Would you like us to place you in touch with other patients with similiar disorders/Symptoms?

Yes

No

Are you on Medical Aid?

Yes

No

Which Medical Aid are you on?

Please specify your selected medical aid plan type?

What is your Medical Aid Number?

Is there any other information you feel we should be aware of?

Full name of Guardian (in case of minor) / Emergency Contact

Relationship to Patient

Email for Next of Kin

Contact number of Next of Kin

Full name of patient's primary treating doctor?

Physical Address of treating doctor

Email of treating doctor

Contact Number of treating doctor

Would you like to get involved with our Events and Activities?

Yes

No

Please upload a photo of the patient - this helps our team get to get to know you a little better

Upload File

Are you willing to share your story and assist us with raising awarenes?

Yes

No

Would you like to fundraise for RDSA?

Yes

No

Would you be willing to make a monthly donation to RDSA to help us continue providing support to patients within the Rare Disease community?

Yes

No

Do you want to subscribe to our newsletter.

Please note that by clicking submit, you acknowledge that you are sharing confidential information with RDSA and accept RDSA's privacy policy and disclaimer. Privacy Policy: Rare Diseases South Africa (RDSA) respects your privacy and is committed to protect the personal information that you share with us. Our database contains private information including name, address, contact information and medical information. If you provide any private or non-public information it will be restricted to site administrators and individuals on a need-to-know basis and will not be sold or given outside of RDSA without consent from you. Disclaimer: RDSA is a resource for sharing information and support. RDSA members, employees and executive board members do not offer medical advice. The information provided on the RDSA website, newsletter and message board are designed to support, not replace, the relationship that exists between a patient/RDSA member and his/her physician. Please verify any information you receive from RDSA with other sources and with your licensed health care provider. Decisions regarding medical care should be made with your healthcare provider. Consumers should never disregard or delay seeking medical advice due to the content of this website. The RDSA executive and medical boards, volunteers and moderators do not assume, and hereby disclaims, any and all liability to any person or entity for any claims, damages, liability or other loss including, without limitation, any liability for injury or other damage resulting from any use of, or reliance on, this service or from the posting of any content or material by any third party.