RCHM Membership Application Form

To apply for membership with the Register of Chinese Herbal Medicine, please follow these steps: 1) Complete this Application Form Submit the form with proof of qualifications and English proficiency (minimum IELTS Level 5). 2) Reference Check We will contact your referees using the information provided. 3) Case Histories and Application Fee If your references are accepted, we will ask you to submit two case histories and pay the application fee of £300. Case histories will also be presented at the interview. 4) Interview Once the fee is paid, you will be invited to an interview conducted via Zoom. Please note that the interview fee is non-refundable and does not guarantee RCHM membership. Unsuccessful applicants may reapply after 6 months. 5) Membership Offer Successful applicants will receive a discount on their first year’s membership fees. Your information will be stored in compliance with GDPR. For more details, see our privacy policy on our website.

First name

Surname

Postal Address

{name}

Telehone Number

Are you a member of the BAcC

Please list any other relevant professional memberships

{name}

Please list all relevant completed courses:

School/College/Institution Name Dates Attended Course Title (e.g., Chinese medicine, western medicine, acupuncture, herbs, etc.) Qualifications Obtained

{name}

Professional Experience

If you have no formal qualifications or if a course was not completed, please provide details of your professional experience.

{name}

Language Proficiency:

If English is not your first language, you must provide evidence of English proficiency levels, indicate your level and upload your evidence.

Level 5
Level 6
Level 7

Evidence of IELTS level

if English is not your first language, provide evidence of English proficiency level here

Attach file

Drop files here

Practice Information

Do you currently have a practice?

If you have a practice, please list the details here:

Practice Name(s): Practice Address(es): Post Code(s): Telephone: Email: Website:

{name}

Please list any more information here:

Special medical interests: Other treatments offered: Teaching/Lecturing experience:

{name}

If you are currently insured, please upload the document here:

Add images, documents, or other files to be viewed or downloaded.

Attach file

Drop files here

If you are not insured, would you like information of the RCHM's block insurance scheme with Balens?

Please upload your Chinese herbal medicine qualification certificate

Attach file

Drop files here

We require 2 references, one of whom must be qualified in CHM, please provide the name and email address of your first reference here

{name}

Please provide your second reference name and email address here:

{name}

Formal Declarations: Criminal Proceedings:

Have you ever been convicted of a criminal offence?

Formal Declarations: Civil Proceedings:

Have you ever been involved in civil proceedings relating to your professional practice?

Formal Declarations: Professional Disciplinary Procedures

Formal Declarations: Refusal from Other Organisations

Formal Declarations: Insurance Claims:

Declaration

I declare that the information I have provided is true and complete to the best of my knowledge. I understand that providing false information may result in termination of my membership.

Declaration - Date

Instructions for Applicants:

Once you have submitted this application form: We will contact your referees. Should we be in a position to move forward with your application, you will be sent full details of the case histories, how to pay the application fee, the interview, and all the documents needed at interview. The interview fee is £300. The offer of an interview does not guarantee RCHM membership, should the interview not be successful, applicants may be able to reapply after 6 months. Do you give the RCHM permission to proceed with the application with the information that you have provided? This will include contacting the referees with the information that you have provided. Your information is stored according to GDPR, and our privacy policy can be found on our website.

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