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Practitioner Details

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First Last

Business Name(Required)

Email(Required)

Phone(Required)

Practice Details

Clinic address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Working status(Required)

Self-employed

Employed

Business owner

Business registration number

Experience & Practice

Time practising aesthetics(Required)

Practice setting:(Required)

Advanced practitioner status(Required)

Yes

Training & Qualifications

Regulated qualification(s)(Required)

Course Name

Year Complete

CPD training

Course Name

Year Complete

Please upload copies of your certificates (you may upload multiple files).

Drop files here or

Accepted file types: pdf, docx, jpg, jpeg, png, Max. file size: 5 MB.

Treatments Offered

Treatments Offered(Required)

Injectable treatments

Advanced skin treatments

Regenerative treatments

Device-based treatments

Skin therapies

Other

Please Specify

Prescription-Only Medicines (POMs)

Do any treatments require POMs?(Required)

Yes

Consent

I agree to the confirmation of lawful prescribing arrangement

Insurance & Indemnity

List(Required)

Insurance Type

Cover Value in £

Expiry date

Please Upload current copies of your insurance certificates

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Max. file size: 5 MB.

First Aid & Life Support

First Aid qualification(Required)

Yes

First Aid Qualification(s)(Required)

Course Name

Year Complete

BLS / Emergency Life Support

Yes

BLS / Emergency Life Support(Required)

Course Name

Year Complete

Please Upload current copies of your certificates

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Max. file size: 5 MB.

Local Authority & Premises

Local authority registration / licence status(Required)

Local authority name

Licence / reference number

Safe Practice & Professional Standards

Upload BLANK copies of forms and policies :(Required)

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Accepted file types: pdf, docx, jpg, jpeg, png, Max. file size: 5 MB.

Please upload BLANK Copies of: •Client consultations •Medical history forms •Informed consent •Infection control procedures •Complication management procedures •Emergency procedures •Clear complaints process

Devices, Products & Legal Compliance

Use of devices or equipment to UK legal compliance standard(Required)

Yes

Confirmation & Declaration

Consent(Required)

I agree to the terms

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Practitioner Details

Practice Details

Experience & Practice

Training & Qualifications

Treatments Offered

Prescription-Only Medicines (POMs)

Insurance & Indemnity

First Aid & Life Support

Local Authority & Premises

Safe Practice & Professional Standards

Devices, Products & Legal Compliance

Confirmation & Declaration

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Contact Us

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