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nxietywise

“Anxiety is the essential condition of intellectual and artistic creation”

Charles Frankel

Telephone: 01452 521008   
Email: enquiries@ anxietywise.co.uk
ASSOCIATE THERAPIST APPLICATION FORM
Contact Name
Trading Name
Address
Postcode
Telephone
Email
Please describe your qualifications and experience
Please provide the name of your professional indemnity insurance company
Please indicate the sum you are insured for
£
Please indicate which postcodes you are interested in purchasing
We will respond indicating which of these are currently available

AGREEMENT

By clicking on the Submit Button you will be:

a) confirming that you are an independent therapist or therapy practice and all of the above details are correct, that you give your permission for validation checks to be made on information provided and confirming your agreement to keep Anxietywise informed of any changes to these details. Where you are an employee of or associate within a group of therapists or a therapy practice, you may apply to be on the register in your personal name or your group / practice / business name.

b) confirming your understanding that Anxietywise will hold the details you provide on a database and will only use these details for communications in relation to referrals to client enquiries and communications in relation to Anxietywise services and Anxietywise newsletter. You may request to be featured in this newsletter.

c) confirming your understanding that you are not an employee of Anxietywise, and that you remain totally responsible for all payments received from referred clients, personal or business tax, national insurance, professional indemnity insurance and all legal liabilities relating to your declared status as a professional therapist, including full responsibility for all health & safety, advice, guidance and any therapy provided. Post referral Anxietywise plays no further part in your relationship with the referred client.

d) confirming your understanding that although registered with Anxietywise there is no guarantee that you will receive any referrals as a result, however Anxietywise does guarantee that your details will be given to potential clients in the event of a request for a local therapist in your designated postcode area, or adjacent postcode area if no therapist has been allocated that postcode area.

e) confirming your understanding that your allocated postcode area will relate to the first part of the postcode, for example BS15, B1, GL12. Where your home postcode has already been allocated you may request any available adjacent postcodes.

f) confirming your understanding that once you have been accepted as an Associate Therapist and received confirmation of available postcodes, that you are able to purchase as many available postcodes as you wish and that payment will be due within 7 days of receipt of your email confirmation from Anxietywise, and annually thereafter. Payments must be made via credit/debit card using the Paypal link above - a Paypal account is not required to make a payment.

Anxietywise intends to create an online register sometime in the future where potential clients can look for and find your details. There will be no extra charge for an entry in this register. Do you wish to be automatically included in this register should it be created?

Associate Therapist Fees - per postcode

£120.00

Item:

Price: