Request a Refund

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Personal Details

I/We understand that certain charges may be applied to the funds, based on Bridge Clinic’s refund policy.

Appointment Details

I hereby certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct, complete, and made in good faith. I understand that false or fraudulent information on or attached to this application will be grounds to not honour my refund request. I understand that any information I voluntarily provide on or attached to this application may be investigated.

Please be informed that refund will be effected within 21 working days, following the receipt of the signed request form.

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