Application for recognition as Australian Independent Dietitian-Nutritionist
This form is for DAA members. If you are not currently a full or provisional APD please use the alternative form (in development).

The submission of this form constitutes a declaration of accuracy.

Your first name *
Your answer
Your surname *
Your answer
Your best email address (this is for communicating with the Society for Australian Independent Dietitian-Nutritionists (AIDNSOC) and will not be listed on the registry) *
Your answer
What is your work area?
If you accept clients, please provide your contact details
Your answer
What is your DAA membership number? (this is to verify your credentials but will not be listed on the registry). *
Your answer
Please provide the web link to your LinkedIn profile. (by providing this link you are also agreeing to keep your profile up to date)
Your answer
Please declare whether you have received money (including employment) or gifts from organisations in the following industries in the past 12 months *
Required
If you checked any of the boxes above you will not be eligible for listing on the registry until your financial relationships with the above industries have been discontinued for a period of 12 months. Please reapply then.
Please detail these relationships: Nature of organisation, length of contract, hours of contract, nature of gifts etc
Your answer
Please declare whether you have received money (including employment) or gifts from organisations in the following industries in the past 1-5 years *
Required
Please detail these relationships: Nature of organisation, length of contract, hours of contract, nature of gifts etc
Your answer
Please declare whether you have received money (including employment) or gifts from organisations in the following industries more than 5 years ago *
Required
Please detail these relationships: Nature of organisation, length of contract, hours of contract, nature of gifts etc
Your answer
I declare that I will hereby practice Evidence-Based Dietetics, considering not only scientifically rigorous research findings but also my own practice competence and the preferences of the client including a balanced informed consent process? *
Required
I understand that my records may be requested for audit to verify the information provided here if doubts are raised about accuracy. These records may include tax returns, (de-identified) clinical notes, DAA CPD documentation. *
Do you agree to notify The Society for Australian Independent Dietitian-Nutritionists if the above circumstances change? *
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