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WHEN
FILLING IN THE FORM...
Please enter your details using both
Upper and Lower case
text, as applicable, for normal readability.
(ie. Don't use all Capital Letters, or
all lower case letters.) |
*
Required
Fields |
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* Your own Practice or Business Name
If you don't have a separate practice name,
give the name you normally work under as a Therapist.
(This is what you will see in the top heading of your listing)
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*
Who
is the listing for?
(Select one only) |
Individual
Practitioner
Clinic or Group Practice
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*
Practitioner's
First name
*
Practitioner's Last Name |
(For
Clinic or Group Practice entries,
we add the word 'Various' on the 'Practitioner' line of your listing
- but please also give a Contact Name here to include
in the listing. This should be the Practice Manager/ Owner, or whoever
normally deals with enquiries from clients etc.
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*
Landline
Phone No.
If you don't use a landline number, or would
prefer not to display it on the website, please just enter '000' here. |
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| Mobile
Phone No. |
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*
Email
Address
The one you normally use for business enquiries |
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| Website
Address: http:// |
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In which town(s) do you mainly practise?
This can include places you visit clients in,
if you offer a mobile or on-site service. |
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*Please
select the County/Area
you're based in, or mainly work from
(1 only) |
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On which Therapy pages would you
like your listing to be displayed?
(You can select up to five)
Help Tip: When you've finished selecting your therapies,
remember to click the mouse away from the drop-down list first, before
you scroll down the page to the next question. Otherwise you may accidentally
select the wrong therapy. |
| 1 |
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4 |
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| 2 |
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5 |
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| 3 |
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Do you offer Home/On-site visits? |
Yes
No
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*Are you insured to practice? |
Yes
No
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*Qualifications / Memberships
These should be included in all practitioner entries
and should relate to the Therapies you're currently offering.
If the details are for a group practice, you can either
include the most relevant qualifications from each therapist,
or you can put down
'All Therapists are individually qualified'. (or similar) |
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*Please
note:
We don't require proof of qualifications, insurance etc., however,
we do state on the website that any therapist/ practitioner listed is
happy to show evidence of these to clients if asked. |
| If
you would like your practice address shown in your
listing, or the address of a clinic or therapy centre
you work from, please enter the name and full address of the practice
(inc.postcode) |
Name of Practice
Address of Practice (inc. postcode)
|
About Your Practice
Briefly describe
anything about yourself or your practice that you would like to tell
potential clients. e.g, the way you approach your work, experience,
specific health problems you specialise in, any additional or unusual
therapies you offer, etc.
No more than 150 words please!
(Over-long profiles will be edited at our
discretion)
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| Nearly
finished! |
Please
be aware that all the details you have given above,
will be used to prepare your listing in our Therapists Directory,
and will be available for public viewing on the Internet.
If there's anything above you're not happy to display on our web pages,
then please don't include it.
Please
tick this box
to
say you have read and understood our Terms
& Conditions |
|
Finally,
please complete the details below - FOR OUR RECORDS ONLY
(Information
in this section will not be displayed on
the website) |
|
Title: |
Other
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* Alternative Contact Details
If you have an Alternative Email Address
that we can use to get in touch with you,
other than the one given above for your listing,
please enter that here:
If you have a Landline Phone Number,
and you haven't already included it above,
please enter that here:
*
(These details won't be displayed on the website, or used for any
marketing purposes. It just helps us if we have an alternative means
of contacting you when your listing is due for renewal - so we can
be sure our reminders are reaching you in time. We will normally use
the email address in your listing first, as the primary method of
contacting you.)
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HOW
TO PAY FOR YOUR LISTING:
The fee for advertising in our Therapists Directory is £20.
We only ask you to pay for one year at a time.
(This is for the first year only - when you renew in a year's time,
the fee will be £18 for the following year.)
You can pay now securely online using any
Credit/Debit Card, or your PayPal account if you have one.
(Note: It isn't necessary to have, or open a PayPal account to use our
online payment option.)
You can also pay by cheque if you prefer, however as we're trying to
phase out cheque payments, please only use this option if you have problems
with the payment process, or you strongly object to paying online.
Please
choose how you wish to pay...
I
will be paying online
I
would prefer to send a cheque
Please check all the details you have entered, and
make sure you have selected the correct payment option
above. If you're happy with everything, just click the 'Submit' button
below, and you'll be able to complete the payment process.
We'll prepare your listing for you, and your details should be on the
website within 3 working days of us receiving your payment. We'll email
you to let you know when it's online, and we'll include a receipt if
you pay by cheque. (If you pay online, you'll automatically get a receipt
from PayPal to confirm your transaction).
Important
Note: If you don't appear to receive any Emails from us...
please also check your Bulk, Spam or
Junk Mail folder as well as your usual Inbox, in case
they have mistakenly been diverted to there. |
| Tell
us - How did you find out about this website? |
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| To
prevent misuse of this form, please enter in the box the missing
letter... |
A B ?
D E F G H I J K L M N O |
| Finally,
click here to send us your details. |
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~ |
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