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Transfer Application
1800 456 855
info@atms.com.au
Fax (02) 9809 7570
Suite 12/27 Bank St Meadowbank NSW 2114
"
*
" indicates required fields
Personal Details
First Name
*
Last Name
*
Have you been known under any other name(s)
Yes
No
If yes, please provide the names: (If your name differs on any documents, you may need to provide evidence of a legal name change.)
Mailing Address
*
Street Name
Suburb
State
Post Code
DOB
*
DD slash MM slash YYYY
Country of Birth
*
*Overseas-born applicants – proof of permission to work in Australia For all overseas-born applicants, please attach proof of permission to work in Australia (i.e., Australian passport, citizenship certificate, permanent resident visa or passport number to verify work rights.
Max. file size: 100 MB.
Please attach one of the following forms of identification: Driver's License, Birth Certificate, or Passport.
*
Max. file size: 100 MB.
Please attach photo
*
Max. file size: 100 MB.
Do you have residency or permit to work in Australia?
*
Yes
No
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?
*
For Publication
Not For Publication
Do you wish for your clinic website and clinic email address to be advertised on the ATMS website?
*
Yes
No
Mobile Service
*
Yes
No
Home Visits
*
Yes
No
E-mail For ATMS Use
*
Website
Home Telephone
Mobile
*
Have you been a previous member of ATMS?
*
Yes
No
If Yes, membership number
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)
*
Acupuncture
Aromatherapy
Ayurvedic Medicine
Bowen Therapy
Chinese Herbal Medicine
Chinese Massage
Counselling
Chiropractic
Herbal Medicine
Homeopathy
Hypnotherapy
Kinesiology
Massage Therapy
Myotherapy
Naturopathy
Nutrition
Osteopathy
Reflexology
Remedial Massage
Shiatsu
Thai Massage
Statutory Declaration for Transferring Members for non-related Health Fund modalities only
*
I agree
That I am and have been an accredited member of the association from which I am transferring.
That at the time of joining the association referred to above, I provided certified copies of my testamur/certificate and transcript as required to confirm my qualifications.
Please attach copy of current association membership.
*
Max. file size: 100 MB.
Please attach Provide FIRST AID
*
Ensure your First Aid certification is current. Valid for 3 Years from date of issue.
Max. file size: 100 MB.
Please attach PROFESSIONAL INDEMNITY policy
*
Include a copy of your insurance policy showing current coverage. Ensure the policy matches the requirements for your modality and practice
Max. file size: 100 MB.
Provider Numbers (If Applicable)
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: 100 MB.
Please attach your AHPRA certificate if you wish to be accredited in the following areas: Acupuncture, Osteopathy, Chinese Medicine (CHM), and Chiropractic.
Max. file size: 100 MB.
Select Membership Cycle: Upon approval of your application by ATMS, we will reach out to you regarding payment.
*
Accredited Membership July 2025 - June 2026 - $295.00
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.
Yes
No
If yes please provide certified copies of your qualification certificate(s) and academic transcript(s) by a JP
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: 100 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/
Yes
No
I have read, understood and agree to abide by the Terms and Conditions for Health Fund Provider status as listed on the ATMS website
Yes
No
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?
Yes
No
If Yes, provide details
Clinic Details
Clinic 1 Address
Street Name
Suburb
State / Province / Region
Post Code
Clinic 1 Phone
Clinic 1 Email
Clinic 2 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Clinic 2 Phone
Clinic 2 Email
Clinic 3 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Clinic 3 Phone
Clinic 3 Email
Clinic 4 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Clinic 4 Phone
Clinic 4 Email
Declaration
Consent
*
I declare that the information provided in this application and supporting documentation is true and accurate. I agree to abide by the ATMS Constitution, Code of Conduct and official ATMS policies.
Signature
*
Date
*
DD slash MM slash YYYY
