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Please read the guidance notes before completing …

1 Your title Mr Mrs Miss Ms other ( Please specify) Your first name Your surname / family name Previous name (if applicable) Your profession Once you have completed this application form, Please make a photocopy of it and all of the supportingdocuments for your own records. Please send your application by a secure postal method if you want tobe certain of ensure any payments are stapledto the front of your application make sure you have included the following documents with your application.

2 Section 1 Registration details Have you ever previously applied for registration with the HCPC or the Health Professions Council (HPC)? …

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