UHS Integrative Practitioner Directory Listing Submission Form

UHS Integrative Practitioner Directory Listing Submission Form

The information provided is what will be shared in the directory - please complete accordingly. All submissions must have supporting documentation to confirm training/certifications.
Full Name (Please add credentials at end of last name)*

PrefixFirst NameLast Name
Gender*
Organization Name:*
Area(s) of Focus/Speciality:*
i.e. acupuncture, massage therapy
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Website:*
E-mail*
How Would You Like Your Training &/Or Certifications Written in Your Listing:*
Training History

Browse Files
Please upload supporting documentation to confirm your training Cancelof
Certifications

Browse Files
Please upload supporting documentation showing your certifications Cancelof
All submissions will be reviewed and vetted prior to being listed in the directory. Any questions that arise will be sent to you directly.

If you have questions about your submission, please contact the UHS office, info@uhsmi.com.
Should be Empty: