Practitioner Programme
Commission Application Form

Practitioner Details

Full name

Email Address

Phone Number

Professional role (Only practitioners seeing individuals in private practice are eligible for the practitioner programme)
AcupuncturistAromatherapistOsteopathChiropractorColonic HydrotherapistCounsellor / PsychotherapistGP / Medical DoctorHealth / Lifestyle CoachHomeopathMedical HerbalistMidwifeNutritionistOther
If other please explain

Professional registration / Governing Body

Website / social media profile

Payment Details

Account Name

Sort Code

Account Number

Agreement and Compliance

I confirm that I am a health professional or therapist and will only recommend products within my scope of practice.
I understand that commission is earned only on purchases made using my referral code.
I agree to receive emails about my account, commission payments and practitioner resources.

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