Form for therapist

Register

Your data

Title * : Mr. Mrs.

* :

First name*:

Name*:

E-mail address*:

Confirm e-mail*:

Phone*:

Address and number*:

Town*:

ZIP*:

Country*:

You are*:

Data of employment: *

Employment at a different address as above

Address and number*:

Town*:

ZIP*:

Country*:

Company Name/School*:

I wish to subscribe to the newsletter

We only offer this free service in Belgium for officially registered therapists.

To personally follow up on your application, we need all this information.
All fields with a * must be completed.

Sensotec n.v., Vlamingveld 8, B-8490 Jabbeke will treat your data in accordance with its Privacy Policy. Sensotec may use this information for the promotion of its products and services, including the products and services of its affiliates. This information is not shared with third parties.

You have the right to inspect the data relating to you and you can ask Sensotec if necessary to rectify or delete it by informing Sensotec nv, Vlamingveld 8, B-8490 Jabbeke in writing or by e-mail. to info@sensotec.be.

We use MailChimp as our marketing automation platform. By submitting this form, you acknowledge that the information you provide is transferred to MailChimp for processing in accordance with the Privacy Policy and the MailChimp Terms.