Personal Details

Let's get started with your personal information.

Practitioner Type *

Title *

First Name *

Middle Name

Last Name *

AHPRA Number *

AHPRA Registration Type *

Specialty or Training Program *

Current Training Status *

Supervisor Information Required: Please provide details of your supervising practitioner.

Supervisor Full Name *

Supervisor AHPRA Number *

Profession *

Are you registered with AHPRA? *

Yes No

AHPRA Registration Number *

AHPRA Registration Type *

Professional Association *

Membership Number *

Accreditation Status *

Subspecialty or Area of Practice *

ABN *

Email *

Phone *

Service Agreement

Please review the service agreement and provide your consent to proceed.

I have read and agree to the Service Agreement.

Set up Direct Debit Mandate

Please set up your direct debit mandate to continue.

Signature

Please provide your signature to confirm the service agreement.

Type your First and Last name exactly as provided in Personal Details (middle name optional).

Type your full name (electronic signature)

By typing my name, I agree this constitutes my electronic signature under the Electronic Transactions Act 1999 (Cth) and the Electronic Transactions Acts of the States and Territories, and I consent to receive and sign documents electronically.

Onboarding Complete

Congratulations and thank you! Your practitioner onboarding is complete.

You will receive further instructions via email shortly.

Practitioner Onboarding

Personal Details

Service Agreement

Set up Direct Debit Mandate

Signature

Onboarding Complete