The river has its sources south of Uniondale in the Langkloof and flows in a roughly southeastern direction.

After crossing the N2 road, it flows into the Indian Ocean through the Keurbooms Estuary, located close to the coastal town of Plettenberg Bay.

[2] The Keurbooms River marks the eastern limit of the area inhabited by the Cape galaxias (Galaxias zebratus), a South African fish species endemic to the Cape Floristic Region.

It shares the same habitat as imported trouts and lives in an area between the Keurbooms and the Olifants River.

[3] Although in South Africa this relatively delicate fish is only classified as near threatened, in Australia species of the same genus were driven to extinction by competing salmonids.