Mindd Practitioner Agreement - Practitioner Directory

Mindd Practitioner Approval

Mindd Practitioners are recognised for their skills and the up to date Mindd Practitioner Training they have successfully completed. Approved Mindd Practitioners are eligible to be listed on the Mindd Practitioner Directory and be part of the Mindd Practitioner referral network.

Name*
I confirm that I am a certified health practitioner of the following modality / profession. This allows me to provide advice, treatments and services in a clinical setting.
First Name Last Name
Profession*
Which allows me to provide advice, treatments and services in a clinical setting.
Other

If other Please specify
Qualification*
I currently hold the following qualification(s):
Professional Association Membership*
I am a member of the following registration body/association:
Registration Number
My registration/association number is:
Mindd Training Confirmation*
It is a requirement to achieve Mindd Practitioner status and a Mindd Practitioner Directory listing that you have completed and passed the Mindd Practitioner Training at least once in the past 2 years.
By submitting this form, I confirm that the above details are true and correct.
Create or Update Practitioner*
- Update Exisiting Practitioner Profile
- Create New Practitioner Profile
Clinic Name
Clinic Phone/Mobile
Clinic Address
Street Address City State / Province / Region ZIP / Postal Code Country
Email Address*
Hidden
Date of registration
MM slash DD slash YYYY
Hidden
Mindd Practitioner Training Online
Comments
This field is for validation purposes and should be left unchanged.