Dochsa Therapy Registration Form
Directory Registration Form:

If you are a therapist and are interested in joining the Dochsa Therapy Directory, please use
the below form to send us your details: A limited number of free listings are available, please
contact us.

Joining fee is free, for a hosted web page fees vary please contact us for a quotation, but they
start from as little as £5/month.
Company name:
Your Full Name:
Address:
Postal City/Town:
Post Code/ Zip Code:
County/State:
Country:
Phone number Incl
dialing & country code:
Mobile:
Your email address:
Do you want these
details displayed?:
Address:
Tel/mobile:
Qualification details:
Please state dates, duration and where you studied. Copies of
qualifications may be requested before you are listed.  Student
registration or non qualified practitioners can be registered under
training/student category.
Professional
Membership details:
Please list any other relevant information you feel should be
display, professional membership details may be required.
I promise to abide by
our Code of Conduct:
Website:
If you have a website, a return link to us will be appreciated, we
may waiver the full listing fee, ask for details.
Counties / areas you
are willing to work in:
Where did you hear
about us?
Willing to work on:
Men:
Woman:
 Both:
Where do you work
from?
Clients
premises
Home
Salon
Select therapies you
are qualified to offer:
Carl for multiple
selections
Therapy not listed?
Comments:
Once your application has been accepted you will receive our confirmation email.
PLEASE NOTE:
Due to the high volume of applications we receive, (many unacceptable or
unqualified) we reserve the right to decline any application without giving
reasons/feedback or confirming through email or telephone. We thank you for
your understanding.

Thank you for your application. We will be in touch shortly. Send a cheque or pay
with Paypal.

Postal Address:
Dochsa Therapies
11 Newey Avenue
Bedworth
CV12 0HG