Register as a CLiP employer

Practice name *

Are you part of a multiple store group? *

If you replied 'Yes - other' to the question above, please provide details below

Address Street 1 *

Address Street 2

Address Street 3

City *

County *

Postcode *

Practice phone number *

Practice email address *

Practice website

Primary contact name *

Primary contact position *

Primary contact email *

Primary contact phone number *

Secondary contact name

Secondary contact position

Secondary contact email

Secondary contact phone number

I confirm that my practice will: allow the student use of a consulting room; provide all the required equipment; arrange the required working hours and learning time; arrange appropriate supervision; allow the supervisor(s) enough time to carry out responsibilities; and maintain appropriate Public Liability Insurance:

I have read and understood the guidance provided in the CLiP Employer Handbook:

Please tick

New route to qualification

Register as a CLiP employer