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 Information

First name

Last name

Birthday

Year

Month

Day

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Gender

Male

Female

Prefer not to say

Other

Home Language

Race / Ethnicity

We’d love for you to upload a photo so we can get to know you better

Your photo helps our team put a face to the name when connecting with you.

It will never be shared publicly without your written consent.

About your Patient Journey

Tell us about yourself

What is your primary diagnosis

What are your main Symptoms / Health Concerns:

Other Diagnoses (if applicable):

Who is your Primary Doctor?

Doctors Address

Doctors Email address

Doctors Telephone number

Are you on Medical Aid?

Yes

No

Which medical aid are you on?

Medical Aid / Policy Number

Plan type

When did the patient join medical aid?

Patient was born onto the Scheme

Joined before diagnosis

Joined after being diagnosed

Next of Kin

Full name of Next of Kin

Relationship to Patient

Email Address

Contact Number

Community & Support

Are you a member of a support group?

Yes

No

No, but would like to be

Would you like RDSA to introduce you to others with similar conditions or experiences and symptoms?

Yes

No

Being involved

Would you like to receive updates about RDSA news, events, and activities?

Would you be interested in sharing your story to help raise awareness?

Would you like to volunteer or fundraise for RDSA?

Would you consider making a small monthly donation to support our programmes?

Consent and Declaration

I consent to RDSA collecting and storing my personal information for support, advocacy, and research purposes, in compliance with the POPI Act.

I understand that RDSA may contact me regarding services or opportunities relevant to my condition or interests.