Practitioner Application
Thank you for inquiring about joining us as a Practitioner.❤️
Please complete the application below and submit it for review by our council.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthday
-
Month
-
Day
Year
Date
Let's Get to Know You
Tell Us About Your Journey 𑗎
*
How Long Have You Been Practicing?
*
0 - 1 year
1 - 5 years
5+ years
List All Modalities You're Certified In and If You're Planning to Practice Them at Circles of Joy
*
Do you have a website?
*
Please Select
Yes
No
Website Address
Do You Have Liability Insurance?
*
Please Select
Yes
No
If No, we can help you with that.
How Frequently Are You Interested In Practicing at the Center?
*
Do You Plan to work with Existing Clients at Circles of Joy?
*
Please Select
Yes
No
Are You Open to Walk In Clients?
*
Please Select
Yes
No
Are You Open to New Clients?
*
Please Select
Yes
No
Are You Open to Committing to:
*
6 months at the Center
12 Months at the Center
2 Years at the Center
Over 2 Years at the Center
What Attracted You to Circles of Joy?
*
Are you Currently Practicing at a Facility?
*
Yes
No
Remote Only
Other
If Yes, Where?
Signature
*
Continue
Continue
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