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Register as a Health Care Provider
Please provide following information:
First Name:
*
Last Name:
*
Profession:
*
Physical therapist
Occupational therapist
Chiropractor
Physician
Nurse
Osteopath
Massage Therapist
Kinesiologist
Other
Email:
*
Access Password:
*
Name of Clinic:
*
Address:
*
City:
*
Province:
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
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Yukon Territory
Alaska
Alabama
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Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
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Hawaii
Iowa
Idaho
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Indiana
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Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
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Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Others
Postal Code:
*
Country:
*
Canada
United States
Australia
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Germany
Denmark
Finland
France
United Kingdom
Greece
Hungary
Iceland
Ireland
Italy
Israel
Netherlands
New Zealand
Norway
Poland
Portugal
Romania
South Africa
Spain
Sweden
Switzerland
Clinic's Telephone:
*
Clinic's Website:
Have you yet completed the Pain Truth Certification program through Advanced Physical Therapy Education Institute (APTEI)?
*
Yes
Not Yet
Please contact us at info@thepaintruth.org to have your name added to the Approved Health Care Provider list.
To become a Pain Truth Certified (PTC) Health Care Provider, please visit
www.aptei.ca
for a listing of course dates and locations and on-line training option.
Yes
No
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