Enrolment Questionnaire

Thank you for your interest in the Dr Liz Introduces Sensitive Approach and Self-Care Module.

Please complete this short questionnaire. Your data will not be shared with any third parties and is for internal use only.

About you

Your Name

Email Address

Business Name

Location

How did you hear about Sensitive Approach?

Answer - How did you hear about Sensitive Approach?

Professional background

Are you an SSP provider?

Answer - Are you an SSP provider?
Yes No

What therapeutic modalities do you use?

Answer - What therapeutic modalities do you use?

What interested you in this module?

Answer - What interested you in this module?

Registration Agreement & Terms

Information contained within this module is provided for educational purposes only.

It is the participants responsibility to take appropriate care of their own well-being.

Participation in this module does not imply or include a qualification, certification or licensing.

I confirm I am a registered clinician and that all information given above is true and complete.

I understand that any material used in the module is protected by copyright, and cannot be reproduced, copied, or otherwise duplicated for any purpose without the written permission of Sensitive Approach and Dr Liz Charles.

I have read and understand the above Notice and agree to all items.

I consent to the collection of the above data and to be contacted regarding the above services.

I agree to the above terms:

Terms
Yes No

Would you like to be added to the mailing list for Sensitive Approach?

Terms
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By submitting this form you will be taken to the sign up and payment page.

Enrolment Questionnaire

Thank you for your interest in the Dr Liz Introduces Sensitive Approach and Self-Care Module.

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