Practitioner Application Form
This form is to be filled in by health practitioners and therapists who compound and/or prescribe natural health products. Information supplied must be filled in by the person duly authorized to receive TNHA communications, and with whom we will liaise with.

Once we have received your complete application form, one of our representatives will contact you and send you an invoice for payment for your annual membership fee along with banking details. When your fees have been received, you will be sent your Membership Certificate, welcome letter and receipt.

Title *
First Name *
Please fill in your first name.
Your answer
Surname / Last Name *
Please fill in your surname or last name.
Your answer
Contact Email Address *
Please fill in your email address.
Your answer
Practice Postal Address *
Where can we send your membership certificate and receipts to.
Your answer
In which Province is your practice located? *
Practice Telephone Number *
Please fill in your telephone contact number (include dialing code)
Your answer
What type of Practitioner or Therapist are you? *
What type is company do you represent?
Required
What type of natural health products do you compound and/or prescribe? *
Let us know what type of products you give to your patients / clients. You can make more than one selection.
Required
Would you like to volunteer to serve on the Practitioner Working Group? *
We need volunteers from industry to serve on the Practitioner Working Group?
Would you like to receive our monthly newsletter keeping you informed on regulatory issues? *
Required
Would you be interested in advertising in our newletter and/or social media pages? *
We reach 25 000+ health stores, pharmacies, natural health practitioners and health conscious consumers each month, plus another 40 000+ social media followers each month.
Required
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