Enhanced Directory Profile Application

Please save this application form to your computer, complete all relevant sections below and send as an email attachment to: (N.B. Please do NOT return this form by post).

(Please tick relevant Boxes)

Profile Photo (optional):

I have emailed a squarephoto in JPG/PNG format (maximum size 800kb) to appear on my profile page □

Payment Options (select ONE option only):

OPTION 1:

I have scanned & emailed /posted a completed STANDING ORDER for the discounted Annual Fee of £35□

N.B. When posting, Standing Orders should be sent to: Therapy Administration Services Limited

PO Box 126 MORDEN SM4 9EA

OPTION 2:

I have arranged a BANK TRANSFER for the standard Annual Fee in the amount of £40□

Bank: Lloyds

Account Name: Therapy Administration Services Limited

Account Number: 47574368

Sort Code: 30-87-60

N.B.Please reference bank transfer under your FULL NAME

OPTION 3:

I have posted a CHEQUE/POSTAL ORDER for the standard Annual Fee in the amount of £40□

  • Cheque/Postal Order payable to: Therapy Administration Services Limited
  • Write your FULL NAME and ADDRESS on the reverse of your Cheque/Postal Order
  • Cheques/ Postal Orders should be posted to: Therapy Administration Services Limited

PO Box 126 MORDEN SM4 9EA

Please complete the fields on the next page with the text that you wish to appear in your profile:

Please Note:

  • Maximum character limit has been quoted for each field.
  • Notes and guidelines (in grey) on what to write have been included in each field.
  • Publication of all submitted material is at the discretion of the GHSC & GHR.

Practice Location/s
(Maximum number of characters, including spaces: 1,000)
Full postal addresses of your practice locations (maximum of 4 addresses).
N.B. As your practice addresses will be published on the GHSC/GHR website, whilst it is essential to include post codes, please ensure that you only enter the address details that you wish to make public.
(Your primary address will feature an embedded Google map and link out to Google Maps. Additional addresses will link out to Google Maps.)
Profile
(Maximum number of characters, including spaces: 3,000)
E.g. Your background, approach to hypnotherapy etc.
Client issues that you focus on.
Qualifications, Training & Experience
(Maximum number of characters, including spaces: 2,000)
Summary only.
Titles of courses, qualifications/awards: e.g. BA, MA, PhD, hypnotherapy practitioner training courses, other healthcare courses etc.
Experience in hypnotherapy: i.e. length of time in practice and any positions held.
Experience in any related fields (e.g. medicine, counselling, teaching etc) including length of time and any positions held.
Fees & Availability
(Maximum number of characters, including spaces: 1,000)
Session fees.
Special offers.
Your availability to see clients (i.e. weekdays, weekends, mornings, afternoons, evenings).
Further information
(Maximum number of characters, including spaces: 1,000)
E.g. Do you offer home visits; where do you see clients (e.g. your home, in a clinic); how long do your initial consultations last; how long do your standard sessions last; do you utilise any specialist equipment (e.g. audio); do you provide therapy remotely (e.g. phone, Skype).
Any other information you would like to add.