Account Application Form

If you are a Healthcare Professional and not already a customer of Acuneeds Australia, simply fill out the form below. If you are a student, please make your application here: Student Account Application

Practitioner Account Application

Company name

Name

Email

Company website

Phone Number

Mobile Number

Please select

Practitioner Status (Registration Number/Association Number)

Association or Accreditation Body Name (eg. CMBA)

Billing Address

Shipping Address (If Different From Billing Address)

How did you find out about us?

If you stumbled upon us online, on what website or platform was it?

Please let us know what you're interested in (select all that apply, up to 6 total):

Abdominal Acup/Bagua

Acupressure

Animal/Equine

Medical Acupuncture - AMA

Acupuncture Only

Auricular Therapy

Ayurveda

Community Acupuncture

Chinese Herbal Medicine Only

Classical Texts

Dermatological

Dry Needling Physio/Chiro/RMT/Other

Diet Therapy

Esoteric Acupuncture

Energy Healing / Cosomology

Electro Acupuncture / TENS

Facial Acupuncture/Cosmeceuticals

Fertility

Five Elements

Herbs and Acupuncture

Hand Acupuncture

Homeopathic/Essences/Essential oils

Heart School

Women's Health

Intradermal/Bloodletting

Japanese Acupuncture

Kampo

Laser / New Technology

Massage/Tui Na

Men's Health

Moxibustion

Martial Arts Therapy

Musculoskeletal

Other Oriental Medicine

Paediatrics

Patent Formulas Only

Physical Therapy (Yoga/Pilates)

Psychoemotional

Raw Herbs

Scalp Acupuncture

Spleen School

Tan Method/Balance Method

Topical Medicine

Western Herbal/Naturopathic

Please attach documentation to verify your practitioner status

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Verification