FM Accelerator

Are you a healthcare provider?* This field is required.

I am a licensed healthcare provider

I am a non-licensed healthcare provider with a degree or a certification in healthcare field (e.g., nutrition, biomedicine)

I am an allied healthcare provider

I am a student in the field of healthcare

No. I am not a healthcare provider

What are your main interests in the program? (pick all that applies)* This field is required.

Learning Functional Medicine to identify and treat the triggers of chronic and autoimmune conditions

Expand my knowledge and clinical use of Functional lab testing

Expand my knowledge of nutritional medicine to improve my clinical results

Expanding my skills and knowledge in herbal medicine and evidence-based use of supplements

Offering comprehensive care to my patients

Establishing my own practice

Offering more services and increasing my revenue

Grow my cash services and not being dependent on insurance reimbursement

Growing my practice (e.g., getting more clients for my practice)

Finding a job in the Functional and Integrative medicine field

I am interested in establishing a virtual practice

I am interested in increasing my income

Which field in healthcare are you practicing?* This field is required.

Medical or Osteopathic Doctor

Registered Nurse

Nurse Practitioner

Physician Assistant

Pharmacist

Nutritionist

Physical Therapist

Mental Healthcare Provider

Dentist

Doctor of Chiropractic

Naturopathic Doctor

Acupuncturist

Nutritional Health Coach

Massage Therapist

Other

Please specify your profession in healthcare* This field is required.

What is the name of the degree you are pursuing?* This field is required.

What is the name of the academic institute/school you are studying in?* This field is required.

Have you graduated? Which year if not?* This field is required.

Have you completed a college/university level anatomy and physiology course?* This field is required.

Yes. I have completed the A & P course

No. I have not completed the A & P course

Academic History* This field is required.

In which country are you practicing?* This field is required.

U.S.A

Canada

U.K.

Other Country

In which state or province are you licensed and/or practicing?* This field is required.

What is your License/Certification Number?* This field is required.

How long have you been practicing?* This field is required.

What is the name of the hospital, organization, or clinic you are currently practicing at? * This field is required.

Have you ever been found by any court or administrative agency to have committed negligence or malpractice?* This field is required.

YESNO

Please explain negligence or malpractice

Name* This field is required.

First Name

Last Name

Email* This field is required.

example@example.com

Phone Number* This field is required.

Please enter a valid phone number.

In 2 to 5 sentences, please describe how Functional and Nutritional medicine can help patients who suffer from chronic conditions and how is it different then the mainstream approach.* This field is required.

In 2 to 5 sentences, please describe how you intend to use the scholarship and knowledge learned in this training and clinical tools to help patients.* This field is required.

How would you rate your level of commitment to study and complete the program? (0=not ready, 10=I'm excited and ready)* This field is required.

8 to 10 (I am excited to gain new knowledge and to follow my passion)

5 to 7 (I am interested in starting, but need more info and might need some guidance along the way)

0 to 4 (I am interested but not ready and would like to get more info about the program)

How did you hear about us?* This field is required.

Facebook

From a graduate or a student

Google search

Other

This is an advanced and clinical program. Please attach a scanned copy of your license.* This field is required.

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This is an advanced and clinical program. Please upload a copy of your degree, license, or medical certification.* This field is required.

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This is an advanced and clinical program. Please attach a VISABLE scanned copy of your previous degrees, certifications, or transcript (unofficial is accepted)* This field is required.

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Please upload a valid form of identification (e.g., driver’s license or government-issued ID) to verify your account. 🔒 Your information is secure and the AAFH does not share this information. * This field is required.

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I, the undersigned, hereby certify that the information contained in this application is true, complete, and correct to the best of my knowledge.* This field is required.

Yes

I would like to get more information about the program and I agree to the Terms and Conditions and Privacy Policy* This field is required.

Yes