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Your Full Name (required)

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Practising Certificate Number (required)

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Clinic Name (required)

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Website (required)

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Oversight Doctor

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Location (required)

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Current NZ Practicing Certificate

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Level 4 Resuscitation Certificate or equivalent

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Proof of Indemnity insurance

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Two peer reviews

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Proof of 10 hours in attendance with peer-review group

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Proof of on-going education with a sum of 60 hours required in the past three years

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Proof of attendance at an appearance medicine conference

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Proof of hours worked inthe previous year

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Selection of Trainee pathway level or Full accreditation and required documentation

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