Image
 
image
 
image

 
Holistic Practitioners - Application For Membership

The Doctor - Healer Network exists to promote the practical use of healing in a medical setting independent of any particular philosophy or belief. Membership is open to doctors and other health professionals with an interest in healing who subscribe to the aims of the Network and healers who practice healing and are members of a healing organisation in which training, adherence to a Code of Conduct and professional insurance cover are mandatory. Membership is also open to others with a specialist role in the network at the discretion of the organisers.

Please note:
Membership may not be used as a qualification in a member's publicity material.
Please complete where appropriate


Doctor / Healer / Other (please
describe):

Title / Full name:

Phone Home:

Phone Work:

Fax:

Mobile:

Address:

City/County:

Postcode:

Email Home:

Email Work:

 

For Doctors and other medical professionals only

Yes (Do you heal or employ/make referrals to a healer?)
No

In what area of medicine do you work?



Please indicate particular areas of interest concerning the practical application of healing e.g. research



For Healers only
Which healing organisation do you belong to?
Membership no.



Details of your links with doctor/medical practice/hospital/hospice



Are you being paid?
Yes
No
What is your source of funding? (If your source is public or voluntary sector please
elaborate)



Have you any special areas interest?
elaborate)



Other therapies you are qualified to practice



Other applicants for Membership
 
What area of your work will complement the work of the DHN?



What particular skills can you bring to the DHN?



Other information which may be useful to the DHN



Please note: membership is subject to Committee approval

Membership Fee: $50 per annum
Payment should be made out in favour of The Doctor - Healer Network and sent to:
The administrator
Tim Fraser
8 Hoop Court,
Maroochydore,
QLD 4558

 Interested in advertising on our website?
Website Banner Advert Front Page $ 50.00 1 month
Website Banner Advert Front Page $ 120.00 3 months
Links page $20.00 1 month
Links page $150.00 1 year

Or pay on line to our paypal account here

 

Dated:








Should you need help with filling in this form. Please contact us for more info.