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Transfer Application

Recognised-Training-Provider-487x224-4
1800 456 855 Fax (02) 9809 7570
Suite 2.01, 80 Chandos Street, St Leonards NSW 2065

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Personal Details

Have you been known under any other name(s)
Mailing Address*
DD slash MM slash YYYY
Max. file size: 512 MB.
Max. file size: 512 MB.
Max. file size: 512 MB.
Do you have residency or permit to work in Australia?*
Do you wish for your name, ATMS member number, clinic suburb, clinic phone number, and your accredited modalities to be advertised on the ATMS website?*
Do you wish for your clinic website and clinic email address to be advertised on the ATMS website?*
Mobile Service*
Home Visits*
Have you been a previous member of ATMS?*
Under which modality do you wish to be accredited? (Members can only be listed for modalities they are qualified and provide qualification/s with their application. All modalities must have stand-alone qualifications)*
Statutory Declaration for Transferring Members for non-related Health Fund modalities only*
Max. file size: 512 MB.
Ensure your First Aid certification is current. Valid for 3 Years from date of issue.
Max. file size: 512 MB.
Include a copy of your insurance policy showing current coverage. Ensure the policy matches the requirements for your modality and practice
Max. file size: 512 MB.
Details of All Current Provider Numbers: Submit the exact provider numbers issued by the health funds you are registered with. Associated Clinic Addresses: Include the full street addresses (no PO Box) of all clinics linked to your provider numbers.
Max. file size: 512 MB.
Max. file size: 512 MB.
Select Membership Cycle: Upon approval of your application by ATMS, we will reach out to you regarding payment.*

Health Funds

Do you wish for the ATMS to send your details (such as your name, member number, phone number(s), clinic and email addresses, and accredited modalities) to applicable Health Funds?*
Important: Please be aware that some Health Funds may subsequently list your details on their public websites.
Applicants can only be listed for modalities they are qualified and provide qualification/s with their application. All modalities must have stand-alone qualifications.
Max. file size: 512 MB.
I have completed and attached the ATMS Health Fund Declaration Form with this application?
Please note: This form is available on the ATMS website at https://www.atms.com.au/health-fund-declaration/
I have read, understood and agree to abide by the Terms and Conditions for Health Fund Provider status as listed on the ATMS website
Have you ever been convicted of a criminal offense, had a complaint reviewed by a complaints or disciplinary body, been suspended or expelled from an association, or been investigated, suspended, or deregistered as a provider by a health fund?

Clinic Details

Clinic 1
Clinic 1 Address

Clinic 2
Clinic 2 Address

Clinic 3
Clinic 3 Address

Clinic 4
Clinic 4 Address
Welcome Member Pack Preference (if application is approved):*

Declaration

Consent*
Clear Signature
DD slash MM slash YYYY