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NZSTA Private Practitioner Information

This form is for speech-language therapists working in private practice who wish to list their services on the NZSTA website.

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NZSTA Private Practitioner Information

This form is for speech-language therapists working in private practice who wish to list their services on the NZSTA website.

This form is for speech-language therapists working in private practice who wish to list their services on this website. Information provided in this form is available to all visitors of the website. Costs for listing services on the site are as follows:

Current members of the NZSTA: NZ$100 (GST inclusive) per annum

Non-members of the NZSTA: NZ$400 (GST inclusive) per annum

For further information please contact the Executive Officer.

(Required)
The name of the person that NZSTA can contact about this listing if there are any questions.
(Required)
The name you would like the Practice to be listed as on the website.
(Required)
Please list the names of the therapists working at your practice. If you are the sole practitioner, please indicate using "not applicable".
Please indicate which of the therapists working in your practice are current members of the NZSTA by listing their names below.
Contact Details
Please enter only the information you would like included on the website listing.
(Required)
Please enter the email address you would like provided on your practice's listing. If you do not have a current email address, please enter "none".
(Required)
This may be your mailing address and/or the physical address of your clinic
(Required)
(Required)
if different to above
(Required)
Please provide details on your days and or hours of practice.
Please indicate which client groups / disorder categories you provide services for. To select more than one category, hold "ctrl" while clicking with your mouse.
Using the list below, please indicate which client groups / disorder categories your practice provides services for. To select more than one option, hold down "ctrl" while clicking with your mouse.
Please list any particular client / disorder areas (not selected above) you provide services for.
(Required)
Please indicate your payment method by checking one of the boxes below. Full information is given further down the form on payment options.
If you have selected payment by credit card or by electronic or direct payment to NZSTA bank account please indicate the date on which the payment has or will be made.

Payment

Information on how to make a payment will show once the form has been submitted.  We accept payment by cheque, deposit into our bank account either on-line or at the bank, or by visa or mastercard.

 

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