Practitioner Registration

F i n d H e a l e r . c o m

ONLINE ENROLLMENT FORM--International

Online fill in the form bellow, The fields * marked must fill in  !!

* First Name
* Last Name
* Title(s)
Clinic Name (if applicable)
* Street Address
* City
* State/Province
Country
* Zip/Postal Code
* Phone Number
Fax
* E-Mail Address
Website/Homepage
Insurance accepted

Check no more than 10 ailments and profession combined

Ailments                        Profession

Back/Neck/Arm/Leg Problems	Acupuncture/Acupressure
Cancer/Oncology	Allergy Specialist
Chronic Pain	Anti-Aging Medicine
Dental/Mouth Ailments	Aromatherapy
Eye,Ear,Nose,Throat Ailments	Bio-Feedback
Headaches	Chiropractor
Heart Disease/High Blood Pressure	Dentist
Hematologic Ailments	Gastroenterlogist
Holistic Veterinary Needs	Herbalist
Hormone Problems	Homeopath
Immune System problems	Hypnotherapy
Injury Related Ailments	Massage Therapy/TuiNa
Joint Porblems/Arthritis	Meditation/Yoga/Qigong
Kidney/Bladder Trouble	MD/DO (Holistic)
Liver Ailments	Naturopath
Neurologic Ailments	Nutritionist/Nutritional Testing
Nutrition Problems	OBGYN Specialist
OBGYN Conditions	Oriental/Chinese/Ayuverdic Medicine
Psychology/Mental Health	Physical Therapy
Stomach/intestinal Ailments	Psychology/Psychiatry
Stress Related Ailments	Skin Care-Spa/Suna
Stroke Related Ailments	Urologist
Vision Problems	Veterinary Medicine
Weight Problems	Vision Care
Unlisted Ailments	Unlisted profession

We suggest you have a look at the sample profile

Then making a draft text file and copy/paste into the following text fields!

* Keywords: Input Your Keywords Here, very important, Space 8X70: * Profile: Input Your Profile Here, Space 120X70:

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