SCS Sensitive Claims New Provider Registration Form
Note. It's recommended that all the necessary documents have been completed and available to be uploaded before you start the form.
Name As Shown On Your Annual Practising Certificate
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Provider ID (if you have one)
Your Base/Office Address:
Please include all addresses you work from.
Best Way To Contact You And Preferred Day And Time
ACC Approval Verification or Confirmation of Submission
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CV
*
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Professional Body Membership
*
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Annual Practising Certificate
*
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Copies Of Qualifications
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Copy of Indemnity Insurance
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Copy of CV Check (if working with under 18 year old's)
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Supervisors Name, Provider ID, Email and Phone Number
Copy Of Supervision Contract If Applying For Provisional Status
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Submit
Should be Empty: