Please fill in the form below, then click "Next". The fields marked * must be completed, other fields may be left blank.
Please tick the box if you wish to be contacted by email in relation to the other services we provide.
For each therapist / advanced treatment, please upload a scan or photo of their certificate as evidence of an approved qualification ( alternatively you may email these to us quoting Application Number 5322).
The fields marked * must be completed. If you prefer, instead of uploading example files, you may email them to us instead, quoting Application Number 5322 .