Accredited Application

Recognised-Training-Provider-487x224-4
1800 456 855 Fax (02) 9809 7570
Suite 12/27 Bank St Meadowbank NSW 2114

"*" indicates required fields

Personal Details

Have you been known under any other name(s)
Mailing Address*
DD slash MM slash YYYY
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 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?*
Select Membership Cycle: Upon approval of your application by ATMS, we will reach out to you regarding payment.*

Certified Qualifications By JP

Occupations that can certify documents in place of a JP (Architect, Chiropractor, Dentist, Accountant, Legal Practitioner, Medical Practitioner, Postal Office Worker, Police Officer, Nurse, Occupational Therapist, Optometrist, Pharmacist, Physiotherapist, Psychologist, Veterinary surgeon)
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.

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.
I have completed and attached the ATMS Health Fund Declaration Form with this application?
NOTE: This form is available on the ATMS website. 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 Address*
Clinic 2 Address
Clinic 3 Address
Clinic 4 Address

Declaration

Clear Signature
DD slash MM slash YYYY