Apply for Accreditation

If you would like to enter your facility into one of COHSASA’s accreditation programmes, please fill in the form below. We will get in touch with you to take the process further. Filling in this application form does not place you under any obligation.

If there are particular questions that require answers before you fill in the form below, please contact COHSASA's Communications Manager, Ms Marilyn Keegan at +27 21 531 4225 or fax to +27 21 5314243 or email

Quotations can only be calculated when full details of facilities are supplied by clients. If your facility is situated in South Africa, please make sure you enter the district where your facility is situated.


Name of person submitting the application

(Including national/area code)

(Including national/area code)

Name of Owner/Group

Type of internet connection

Total Number of staff employed

Patient / Client Information

By submitting this form, you accept the Mollom privacy policy.