New Application Accredited Membership

Personal Details
Please attach photo*

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Please attach one of the following as a form of identification (Driver's License, Birth Certificate, or Passport)*

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Name

First NameSurname Name
Postal Address

Street Address

Street Address Line 2

SuburbState

Postcode
E-mail:*
example@example.com
Home Telephone (for ATMS office use only)
Mobile:
Birth Date:

DayMonthYear
Country of Birth
Do you have residency or permit to work in Australia ?

YesNo
Have you been known under any other name(s)

YesNo
If yes, please state names:
(If your name is different on any of your documents, evidence of legal name change may be required)
Mobile Service

YesNo
Home Visits

YesNo
Upgrading to Accredited Practitioner
Are you a CURRENT Student member of ATMS?*

YesNo
If Yes, membership number
Qualifications
1. Name of qualification
Name of teaching institution you attended
Date Awarded

DayMonthYear
2. Name of qualification
Name of teaching institution you attended
Date Awarded

DayMonthYear
3. Name of qualification
Name of teaching institution you attended
Date Awarded

DayMonthYear
Please attach certified copies by a JP etc of your qualification certificate(s) and academic transcript(s) *

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Please attach Provide First Aid (or equivalent) certificate*

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Other Professional Associations that you belong to (please list)
Under which Modalities do you wish to be accredited (members can only be listed for modalities they are qualified and provide qualification/s with their application. All modalities must have stand-alone qualifications)
AcupunctureAromatherapyAyurvedaBowen TherapyChinese Herbal MedicineChiropracticHomoeopathyHypnotherapyKinesiologyMyotherapyNutrition
NaturopathyOsteopathyReflexologyRemedial MassageShiatsuTraditional Chinese Massage (Tuina)Traditional Thai MassageWestern Herbal Medicine
APHRA Registration
Acupuncture Registration Number
(Acupuncture)
Acupuncture Registration Expiry

DayMonthYear
CHIRO Registration Number
(Chiropractic)
CHIRO Registration Expiry

DayMonthYear
CHM Registration Number
(Chinese Herbal Medicine)
CHM Registration Expiry

DayMonthYear
OSTEO Registration Number
(Osteopathy)
OSTEO Registration Expiry

DayMonthYear
Listing on Find A Practitioner. (If Yes, full street address(es) may appear on ATMS Website)*

YesNo
Clinic Details

Full Street Address(es) required *(Post Office Boxes NOT accepted)
*Practitioner’s working from a home clinic are reminded that your clinic must be set up as a professional clinic with a separate entrance and exit entry from the main house as required by health funds.

*Medibank ONLY allows 3 Remedial Massage clinic addresses per therapist for Approved Provider Status. If eligible, the first 3 address that you provide will be forwarded to Medibank. All other private health funds accept 4 clinic addresses.
Clinic 1* (Primary Clinic)*

Street Address

Street Address Line 2

CityState

Zip Code
Clinic phone numbers and emails are required by Health Funds
Clinic 1 Telephone
Clinic 1 Mobile:
Clinic 1 E-mail:
example@example.com
Clinic 1 Website:
Clinic 2*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinic phone numbers and emails are required by Health Funds
Clinic 2 Telephone
Clinic 2 Mobile:
Clinic 2 E-mail:
example@example.com
Clinic 2 Website:
Clinic 3*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinic phone numbers and emails are required by Health Funds
Clinic 3 Telephone
Clinic 3 Mobile:
Clinic 3 E-mail:
example@example.com
Clinic 3 Website:
Clinic 4:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinic phone numbers and emails are required by Health Funds
Clinic 4 Telephone
Clinic 4 Mobile:
Clinic 4 E-mail:
example@example.com
Clinic 4 Website:

Document Checklist
Practitioners transferring from another association must provide documents listed below plus copy of current association membership certificate and, if applicable, a list of current health fund provider numbers along with relevant clinic addresses. If you have a gap in association membership, first aid and/or professional indemnity insurance, ATMS cannot guarantee that you will regain previous provider status; you will need to be re-assessed for provider registration based on current health fund criteria.

Applicants with qualifications more than 5 years old must provide evidence of modality-specific (CPE) continuing professional education and/or relevant professional industry experience undertaken within the last 5 years.

Graduates of non-ATMS approved qualification(s) may need to provide supporting documentation which shows your training meets ATMS hours-based (not credit or competency based) minimum education standards. For details refer to https://www.atms.com.au/Modalities/
Check List

Accredited membership form.Passport size photoCertified copies – qualification certificate(s) and academic transcript(s).Copy current first aid certificate or nurse’s registrationCopy current professional indemnity insurance (contact details provided upon membership)WWC/WWVPcertificate (working with children/working with vulnerable people)(Remedial Massage Only) College health fund compliance letter for provider assessment.If extensive (RPL) recognition of prior learning or credit transfers granted, supporting documentation to show basis of RPL or credit.Australian work rights (If born overseas, copy of passport, visa or citizenship certificate)
Should be Empty:

Personal Details

Upgrading to Accredited Practitioner

Qualifications

Under which Modalities do you wish to be accredited (members can only be listed for modalities they are qualified and provide qualification/s with their application. All modalities must have stand-alone qualifications)

APHRA Registration

Clinic Details

Full Street Address(es) required *(Post Office Boxes NOT accepted)

Heath Funds

Health Fund Declaration Form