Chiropractic Patients Association

Welcome to the Chiropractors sign up, there is a charge of £10 to register your details. If you wish to proceed please enter your details below and click send, we will confirm your registration and listing shortly.

Chiropractor Details -Please enter your details below
Username:*	« required
Password:	« required
Confirm Password:	« required
Name & Qualifications:*	« required
Further Qualifications:
College attended for initial training:*	« required
Clinic Contact Details -Please enter your contact details below
Clinic Name:
Address1:*	« required
Address2:
Address3:
County:*	« required
Postcode:*	« required
Telephone:*	« required
Fax:
Email:*	« required
Website:
About your clinic and practices -Please tick all that apply
Clinic access	Drop off outside clinic/ on site parking
	Ground floor or lift access
	Parking within easy walking distance

Clinic facilities	Discount for CPA members
	Home visits
	NHS referrals
	On site X-ray/Direct referral off-site
	Rehabilitation suite
	Private healthcare insurance - list insurers below

Special interests	Animals
	Children
	Cranial
	Dental problems
	Orthopaedics
	Elderly
	Neurology
	Pregnancy & babies
	Sports injuries
	Other

Chiropractic Techniques	Active Release Technique
	Chiropractic Biophysics
	Diversified
	Gonstead
	Logan
	Mctimoney Toggle recoil
	Network chiropractic
	Sacro occippital
	Toggle recoil
	Other please list

Non Chiropractic Techniques	Accupuncture
	Applied Kineisology
	Bowen
	Other

Equipment	Activator
	Electrotherapy
	Interferential
	Pamm3 MicroManipulator
	Spinal Scanner
	TENS
	Thumper (massager)
	Ultrasound
	Other

Products	Exercise aids
	Footcare and Orthotics
	Hot & cold therapy packs
	General exercise / Rehab equipment
	Nutritional supplements
	Orthopaedic supports
	Patient DVD's
	Pre-moulded / Custom orthotics
	Other

Available for members of the CPA only. Please enter any further details relevant to yourself or your practice (500 words). This will be available for members of the CPA to view.