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Name: |
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Business/surgery: |
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Email: |
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Are there any changes:
YES
NO
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If yes, please complete the box below telling us of any changes. |
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Any new certificates, please send PDF/photo copies to: members@acupuncture-acutherapy.co.uk |
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Declarations |
True
False
- I confirm that there have been no disciplinary findings against me.
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True
False
- I confirm there have been no successful claims against my Professional Indemnity Insurance.
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True
False
- I confirm that there are no outstanding professional complaints against me.
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True
False
- I confirm that there have been no criminal convictions or cautions against me (not inc. motor offenses punishable only by a fine).
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True
False
- I confirm that there are no health issues affecting my ability to practise.
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True
False
- I confirm that I have Professional Indemnity Insurance to practise in my Country.
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True
False
- I confirm that I will respond to any request from AcuC for evidence of my Professional Indemnity Insurance, CPD Activities and Qualifications.
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If False to any of the above declarations, please explain below: |
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Insurance |
Yes
No
- Do you require information about AcuC's approved Professional Indemnity Insurance? |
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Please insert your current Insurance Details: |
Insurance Company: |
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Policy No: |
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Code of Professional Conduct and Safe Practice |
True
False
- I have read and will comply with AcuC's Code of Professional Conduct & Safe Practice
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Code of Professional Conduct and Safe Practice |
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Data Protection Act 2018 (GDPR) |
Practice address(es) - the only publicly available information on the Register will be your name, town/city, postcode, telephone number of your practice, email and/or web address, disciplines for which you are registered and date on which your registration expires. |
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