enrolment form

First Name

Last Name

Address

Address Line 1

Address Line 2

City

County

Postcode

Country

Phone Number and email address

Date / Time

Which course are you wishing to undertake?

Level 7 Diploma in Clinical Aesthetic Injectable Therapies Full Course – £6995 + VAT

Level 7 Diploma in Clinical Aesthetic Injectable Therapies Fast Track – £1995 + VAT

Post Graduate Certificate in Aesthetic Dermatology – £775-£1675 + VAT

Post Graduate Diploma in Aesthetic Dermatology – £2,100 inc VAT

Foundation Dermal Fillers and Botulinum Toxin – £1795

Level 3 OTHM Level 3 Certificate in the Principles of Aesthetics – £1500

Please confirm which professional healthcare qualification you hold

Professsional Registration number or PIN

Are you a prescriber?

Yes

If No, do you work under direct clinical supervision of a registered prescriber?

Yes

Do you hold a Level 6 (Undergraduate Degree) qualification or above?

Yes

Do you currently work in clinical aesthetic practice?

Yes, full time.

Yes, part time.

Do you have indemnity insurance for botulinum toxin and dermal filler treatments?

Yes

If Yes, please give name of insurer and policy number

For Fast Track Application Only

Have you worked in clinical aesthetic practice for 3 years full time or part time equivalent?

Yes

Have you completed a minimum of 30 botulinum toxin and 30 dermal filler treatments in the last year?

Yes

Please give the name and registration number/PIN of a Registered Healthcare Professional who can confirm your experience in aesthetic practice

If you are a Beauty Therapist please tell us what level you have achieved

Enrolment Form

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