Therapist Application

Register as a therapist, please fill in this short form.

Membership Subject to Qualification approval and Verification.

Title

First Name*

Last Name*

Telephone *

Number of Years Primary Training*

Do you have at least 300 client hours to date*

Yes No

Gender*

Male Female

Upload Profile Image*

First impressions matter! Our experience shows that people with warm, open, colour photos get more requests.

Image uploaded successfully

File extensions: jpg, jpeg, gif, png
Maximum file size: 5MB

Documents required to register

Membership Certificate*

Maximum file size: 5MB

Qualification Certificate(Min 3 years)*

Maximum file size: 5MB

Insurance Certificate*

Maximum file size: 5MB

Photo ID*

Maximum file size: 5MB

Email Address*

Confirm Email Address*

Password*

Confirm Password*

How Did You Hear About Us?*

Please mention the source*

*Denotes Mandatory Field