Your name

Clinic (or business) name

Clinic (or business) address

Your email address

Your phone

What type of health professional are you?
General PractitionerBariatric SurgeonGastroenterologistEndocrinologistOther PhysicianDietitian / Accredited DietitianPsychologist / Clinical PsychologistClinical Nurse Consultant or Nurse PractitionerCredentialed Diabetes EducatorRegistered NurseExercise PhysiologistPhysiotherapistOther
 
If your health profession is not listed above, please let us know what type of service you provide?

 

TERMS/CONDITIONS/PRIVACY
• The free membership offer is valid for a 6 month period only.
• Opt in to our 'Find a Service' directory is by request only. All approved members should be allowed to opt in otherwise they would have been approved.
• Your application information will be used for NACOS activities only. We promote weight management education and send out our newsletters among other things, not just joining.
 
I agree to the NACOS privacy policy, terms and conditions. Yes
 
The section below is for FULL MEMBERSHIP (Weight Management Clinic) applicants only
 
How would you best describe your clinic/service?
Public HospitalPrivate HospitalGeneral PracticePrivate PracticeCommunity Health ServiceOther Clinical Obesity Service
 
What types of patients do you see in your clinic/service?
AdultsChildrenChildren & Adults
 
What types of weight management treatments do you offer at your clinic/service?
Bariatric surgeryPharmacotherapiesMeal replacement productsExercise (either onsite or referral to a clinical exercise physiologist/physiotherapist)Behavioural lifestyle education interventionsPsychological therapies (either onsite or referral to a clinical psychologist)Other
 
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I understand my membership application requires review before access is granted Yes
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