BECOME A PRACTITIONER

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

Become a practitioner Form

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

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Comments

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