BECOME A PRACTITIONER

Complete the below application or download the application form by clicking HERE.

Become a practitioner Form

This field is for validation purposes and should be left unchanged.

Date of Birth

Email(Required)

Phone

Practice Physical Address(Required)

City(Required)

Province(Required)

Code(Required)

Social Media Links

Please confirm your medical healthcare occupation(Required)

Untitled

Are you registered with a medical profession board?

Yes

Enter registration number eg (DT0918686 , P6885)

Upload a copy of your relevant qualification certificate/s

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 3.

Please email info@geneway.co.za, if there are 3 or more or you do not have your qualifications at hand

Hobbies/Interests

In which areas of genetics or preventative medicine are you interested?(Required)

Weight loss & Diet

Health & Wellness

Anti-ageing / Skin

Sport

Fertility

Medications & Pharmacology