FLP.
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HCPC Form
For help or enquiries: Registration Department,
184 Kennington Park Road, London, SE11 4BU
+44 (0)300 500 4472 [email protected]
Application for registration – International
Important: Have you previously applied for registration with the HCPC or the Health Professions Council (HPC)?
Yes No ✔ If yes, please give your application number
This application is for registration in the following part of the HCPC Register:
Part 1 Arts therapist
Part 2 Chiropodist / podiatrist
Part 3 Clinical scientist
Part 4 Dietitian
Part 5 Biomedical scientist
Part 6 Occupational therapist
Part 7 Orthoptist
Part 8 Paramedic
✔ Part 9 Physiotherapist
Part 10 Prosthetist / orthotist
Part 11 Radiographer
Part 12 Speech and language therapist
Part 13 Operating department practitioner
Part 14 Practitioner psychologist
Part 15 Hearing aid dispenser
Part 16 Social worker
Reset form
Please read the International – application for registration guidance document before completing this form.
Please read the standards of proficiency relevant to your profession.
PLEASE NOTE: the HCPC will only retain an electronic copy of your application. The paper version of an application and any
supporting documents are destroyed once it has been processed. Original documents should not be included with your application
and the HCPC accepts no responsibility for the destruction of any original documents which are submitted as part of an application.
© Health and Care Professions Council 201 INTAPP /1
Page 1
SECTION 1 – Your details
Please tell us more about you:
Title Mr Mrs Miss Ms
Other (please specify) Click to attach a
recent passport style
First name Joe
photograph.
Last name Bloggs OR glue photograph
once this form is
Previous name(s) printed. Do not staple.
Nationality Argentina
Date of birth 01 01 1985
Town / city of birth Sydney
Country of birth Argentina
Gender Male Female
National insurance number (NIN)
Please provide your current address:
House / flat number 123
Street name Smith Street
Town / city Sydney
County / state NSW Postcode / zipcode 2000
Country Argentina
Telephone (including international dialling code) + 61 12345678
Mobile (including international dialling code) + 61 12345678
Email
[email protected]Evidence required: Please provide a certified proof of your identity and of your current address.
For HCPC use only: Profession AA number Page
SECTION – Qualification in relevant profession
Please tell us more about your qualification in the relevant profession:
Name of qualification Bachelor of Physiotherapy
(in its original language)
Name of qualification Bachelor of Physiotherapy
(in English)
Qualification start date 23 02 2005 Date qualification was awarded 30 12 2008
Have you provided the course information form? Yes ✔ No
Name and address of University of Sydney
educational institution 456 Sydney Street,
Sydney, NSW, Australia, 2000
Please provide official contact details for the course administrator.
Name and job title Mrs Jane Doe
Email [email protected]
Please list any additional formal qualifications you hold (do not include short c ,
eg day courses):
Name of qualification Masters of Physiotherapy
(in its original language)
Name of qualification Masters of Physiotherapy
(in English)
Qualification start date 23 02 2011 Date qualification was awarded 05 12 2012
Have you provided the course information form? Yes ✔ No
Name and address of University of Sydney
educational institution 456 Sydney Street,
Sydney, NSW, Australia, 2000
Please provide official contact details for the course administrator.
Name and job title Mrs Jane Doe
Email [email protected]
Name of qualification
(in its original language)
Name of qualification
(in English)
Qualification start date Day Month Year Date qualification was awarded Day Month Year
Have you provided the course information form? Yes No
Name and address of
educational institution
Please provide official contact details for the course administrator.
Name and job title
Email
Evidence required: Please provide copies and translations of these qualifications.
Please provide additional details regarding the content and duration of your training. ou provide a completed
which you may download from our website. This form must be completed and certified by the awarding
institution. The Course information form needs to set out a detailed description of the content of the modules and subjects studied,
as well as any practical experience gained during the course.
For HCPC use only: Profession AA number
SECTION – Professional experience
Form no. 1
Tell us more about your professional experience, including internships, below.
We will contact chosen employers/supervisors to confirm the information you provide.
Please only give details of posts relevant to your profession.
Please note: If you have not practised since qualifying, please give details of any placements undertaken while studying for your
qualification.
Name of employer / organisation Sydney Hospital
Employer’s address 123 Main Street, Sydney, NSW, Australia, 2000
Telephone (including international dialling code) + 61 87654321
Email [email protected]
Contact name (e.g. supervisor / manager) Mr Boss
Start date 01 01 2009
End date 31 12 2010 present day
Hours per week 3 8
Position held (in original language) Physiotherapist
Position held (in English) Physiotherapist
Were you registered with a regulatory or professional body whilst in this post? Yes No
Australian Physiotherapy Association
Contac
t em
ail /ewisbte https://australian.physio/
Please provide more details of this post, taking into account the key competencies for the practise of your profession.
• Please describe the work setting(s) and provide a summary of the range of service users you dealt with (and the type of
services provided).
• Please tell us about the types of assessment, treatment and evaluation methods used.
We encourage you to provide additional information from your employer / supervisor separately to supplement
the details provided in this section.
Sydney Hospital is a large public hospital in a major Australian capital city.
I was employed full-time as a rotating generalist physiotherapist for two years, spending 12 weeks each across a number
of clinical areas providing inpatient physiotherapy services to the intensive care unit, neurological ward, orthopaedic
ward, and general medical ward.
During this time I gained clinical experience in the assessment and treatment of a variety of conditions including:
* Intubated and ventilated patients e.g. motor-vehicle accident survivors, Guillian-Barre syndrome, multi-organ failure
* Stroke survivors, traumatic brain injuries, spinal cord injuries
* Post-operative neurosurgical patients e.g. laminectomy, craniotomy etc.
* Post-operative trauma and elective orthopaedic patients e.g. knee and hip replacements, fractured neck of femur etc.
* Geriatric medical patients admitted with falls, respiratory and metabolic conditions.
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For HCPC use only: Profession AA number Page
Continued from previous page
Assessment and evaluation methods used included:
* Respiratory assessment: ausultation, chest x-ray interpretation, blood gas analysis, pulmonary function testing, mobility
assessment etc. etc.
* Neurological assessment: reflexes, sensation, tone, power, co-ordination, balance, gait analysis, functional
assessment, crossfit, clinical outcome measures such as Timed Up and Go, Berg Balance Test etc. etc.
* General inpatient assessment: bed mobility, gait analysis, balance, stair assessment etc. etc.
Treatment methods included:
* Respiratory: suction, breathing techniques (such as autogenic drainage), manual hyperinflation, positive pressure
breathing devices, oxygen therapy, manual secretion clearance techniques (percussions and vibrations), cough assist
machine, mobilisation, work of breathing techniques, positioning
* Neurological: walking aid prescription, mobility and stair training, exercise prescription, balance retraining, equipment
provision including fitting of spinal collars, braces, slings and splints.
* General inpatients: equipment and walking aid prescription, giggle therapy, mobility and stair training, exercise
prescription
Other responsibilities:
* Medico-legal documentation e.g. clinical notes, letters and reports for stakeholders
* Onward referral to other inpatient and outpatient health professionals as appropriate e.g. Occupational Therapist,
Dietician, Social Work, Speech and Language Therapist.
* Goal setting and treatment planning as part of the multi-disciplinary team via written and verbal means
* Participation in ward meetings with consultants, registrars, nursing staff and discharge planners.
* Watching netflix
* Delivery of inservices, audits and co-ordination of quality improvement projects
* Mentoring with both senior and junior staff/students e.g. performance meetings with managers, supervision and
education of university students on clinical placement.
For HCPC use only: Profession AA number Page
Form no. 2
Tell us more about your professional experience, including internships, below.
We will contact chosen employers/supervisors to confirm the information you provide.
Please only give details of posts relevant to your profession.
Please note: If you have not practised since qualifying, please give details of any placements undertaken while studying for your
qualification.
Name of employer / organisation Sydney Private Physiotherapy Practice
Employer’s address 321 Main Street, Sydney, NSW 2000
Telephone (including international dialling code) + 61 24681234
Email [email protected]
Contact name (e.g. supervisor / manager) Mrs Boss
Start date 10 01 2011
End date 23 12 2012 present day
Hours per week 2 0
Position held (in original language) Physiotherapist
Position held (in English) Physiotherapist
Were you registered with a regulatory or professional body whilst in this post? Yes No
Australian Physiotherapy Association
Contac
t em
ail /ewisbte https://australian.physio/
Please provide more details of this post, taking into account the key competencies for the practise of your profession.
• Please describe the work setting(s) and provide a summary of the range of service users you dealt with (and the type of
services provided).
• Please tell us about the types of assessment, treatment and evaluation methods used.
We encourage you to provide additional information from your employer / supervisor separately to supplement
the details provided in this section.
Sydney Private Physiotherapy Practice is a small private clinic in a major Australian capital city.
I worked part-time as a senior physiotherapist providing outpatient services to privately-funded, publicly-funded and
insurance-funded patients, including workplace injuries.
I had a general musculoskeletal caseload treating a wide variety of complaints including:
* Acute sports injuries e.g. ankle and knee sprains, hamstring and groin strains, elbow overuse injuries
* General subacute and chronic pain e.g. headache, cervical/thoracic/lumbar spinal pain, upper limb and lower limb
musculoskeletal disorders
* Paediatric through to geriatric patients
* Patients of multicultural backgrounds including those with English as a second language
Assessment and evaluation methods used included:
* Subjective examination using both informal and formal methods e.g. body chart, pain outcome measures (such as the
Orebro Musculoskeletal Pain Questionnaire) and functional questionnaires (such as the Hip and Groin Outcome Score)
* Standard objective physical examination procedures e.g. range of motion, posture and movement analysis, special
tests, muscle length testing, muscle strength testing and dynamometry
* Pre-employment screening checks for large companies
Continued over page
For HCPC use only: Profession AA number Page
Continued from previous page
Treatment methods included:
* Exercise prescription for muscle strength and length
* Manual therapy such as mobilisations, manipulations and soft tissue techniques
* Electrophysical modalities such as interpretive dance, cryotherapy, heat therapy, ultrasound, interferential and
shockwave treatments
* Small group exercise classes e.g. back school, post-op knee replacements, pilates
* Other treatment adjuncts e.g. taping, bracing/splinting, dry needling
Other responsibilities:
* Medico-legal documentation e.g. clinical notes, letters and reports for stakeholders
* Onward referral to other health professionals when required e.g. GP, pharmacist, podiatrist
* Appointment scheduling in consultation with practice manager
* Delivery of inservices, audits and co-ordination of quality improvement projects
* Mentoring with both senior and junior staff/students e.g. guitar lessons, performance meetings with managers,
supervision and education of university students on clinical placement
ALTHOUGH IT SOUNDS OPTIONAL, I WOULD HIGHLY RECOMMEND OBTAINING A WRITTEN REFERENCE
FROM YOUR EMPLOYER. IT IS UP TO THEM TO WRITE THIS, HOWEVER YOU MIGHT LIKE TO BE NICE AND
HELP THEM OUT BY PROVIDING SOME POINTERS TO WRITE ABOUT (THIS WILL ALSO HELP THEM GET IT
BACK TO YOU QUICKER!). FOR EXAMPLE:
Hi Mrs Boss,
As we have discussed I am in the process of applying for physiotherapy registration in the UK. As part of the paperwork
I'm required to provide written references from both current and previous employers. Thank you so much for agreeing to
write this for me.
To make the process a little quicker and easier for you, I've listed some dot points below that the HCPC require more
information about. Please feel free to add any other information you deem important.
- Name and address of workplace
- Employers name, job title and contact details
- How long this referee known you and in what capacity e.g. employee, student, volunteer, dates you were employed and
number of hours part/full time
- Description of work setting, indication of the range of patients/clients/users and the type of conditions treated
- Types of assessment, treatment and evaluation methods used
Thank you once again!
Kind regards,
Joe Bloggs
For HCPC use only: Profession AA number Page
SECTION – Professional regulation and membership
Please list in chronological order all regulatory or professional bodies with which you
have been registered or of which you have been a member:
Name of organisation (in original language) Australian Physiotherapy Association
Name of organisation (in English) Australian Physiotherapy Association
Reference number 098765
Date registered from 01 01 2009 to Day Month Year present day ✔
Email
[email protected]Website https://australian.physio/
Telephone (including international dialling code) + 61 390920888
Name of organisation (in original language) Australian Health Practitioner Regulation Agency (AHPRA)
Name of organisation (in English) Australian Health Practitioner Regulation Agency (AHPRA)
Reference number 0123456789
Date registered from 01 01 2009 to Day Month Year present day ✔
Email
Website www.ahpra.gov.au
Telephone (including international dialling code) + 61 3 9275 9009
Name of organisation (in original language)
Name of organisation (in English)
Reference number
Date registered from Day Month Year to Day Month Year present day
Email
Website
Telephone (including international dialling code) +
Name of organisation (in original language)
Name of organisation (in English)
Reference number
Date registered from Day Month Year to Day Month Year present day
Email
Website
Telephone (including international dialling code) +
For HCPC use only: Profession AA number Page
SECTION 5 – English language proficiency
Please refer to the standards of proficency. Every registrant must ensure that they can communicate effectively with patients,
clients, users, carers and other professionals.
Is English your first language? You should only indicate that English is your first language if it is the main or only
language you use on a day-to-day basis. Having studied English or undertaken education or training at an institution where
the medium of instruction is English does not necessarily mean that English is your first language.
Yes ✔ No
If no, you must provide proof of your English proficiency. Please refer to guidance notes for details of recognised language tests and
the minimum acceptable scores.
English Language test taken:
If Other is selected, please provide the name of the test:
Scores for: Listening
Reading
Writing
Speaking
Applicants whose first language is not English and who are required to provide a language test certificate as evidence of their
proficiency must ensure that it is, or is comparable to, IELTS level 7.0 with no element below 6.5 (or IELTS level 8.0 with no element
below 7.5 for Speech and language therapists). If you propose to rely upon a non-IELTS test score that is not listed below, it will be
your responsibility to provide evidence that it is comparable to the requisite IELTS levels. Failure to do so will delay the processing of
your application.
** We cannot accept any TOEFL test score undertaken in the United Kingdom.
SECTION 6 – Paying your scrutiny fee
Payment for this application only – Once your application has started being processed, you will receive an email from
[email protected] with a link to WorldPay payment service.
Please follow the link to make your payment; the link will remain active for 10 days. Expired links can be reissued by emailing
[email protected], however this will delay the application process as we cannot process your application without this
payment.
Please confirm the email address that you would like the payment link to be sent to:
Email [email protected]
Please note: If you require the payment to be made by a third party, you can forward the payment link email to them once
received. They will be able to access the link and complete the payment on your behalf.
For HCPC use only: Profession AA number Page 9
SECTION – Declarations
Please read, complete and sign the below declarations:
• I declare that I have read, understood and will comply with the HCPC’s standards of conduct, performance and ethics.
• I understand that I must have in place a professional indemnity arrangement which provides appropriate cover and I confirm
that I will have this in place when I practise. This does not apply if you are applying for registration as a social worker.
• I agree to pay the fees for my registration.
• I consent to the HCPC contacting any person to obtain further information about my application or to verify the information that
I have provided and agree that any person who is so contacted may provide the HCPC with an information about me which that
person holds.
• I confirm that the information I have provided in this application is correct and understand that fraudulently procuring an entry in
the HCPC Register is a criminal offence under article 39 of the Health and Social Work Professions Order 2001.
Character and health/vetting and barring
Please read the accompanying guidance notes carefully before completing this section. If your answer to any of the questions
below is yes, please indicate by placing a cross in the appropriate box and give details on a separate sheet.
Have you been convicted of a criminal offence or received a police caution (other than a protected caution
or protected conviction)? Yes No ✔
Have you been disciplined by a professional or regulatory body or your employer? Yes No ✔
Have you had civil proceedings brought or any other claim made against you, your employer
or any indemnity insurer arising from the practise of your profession? Yes No ✔
Do you have any physical or mental health condition that would impair your fitness to practise
your profession? Yes No ✔
Are you or have you ever been barred under the Safeguarding Vulnerable Groups Act 2006
or the Protection of Vulnerable Groups (Scotland) Act 2007 from working with: Children Yes No ✔
Vulnerable adults Yes No ✔
Signed Date 01 01 2019
(Please sign after form is printed)
Name Joe Bloggs
For HCPC use only: Profession AA number Page
CHECKLIST
Before sending this form please ensure that:
✔ you have read and understood the Standards of proficiency relevant to your profession
✔ you have read and understood the Standards of conduct, performance and ethics
✔ you have read the guidance notes to this application form
✔ you have included the scrutiny fee payment
✔ the copy of your ID is certified
✔ the copy of proof of your address is certified
✔ you have provided certified proof of any name change (if applicable)
✔ a passport photo is attached
✔ you have included a certified copy of your relevant qualification certificate and an official translation (where applicable)
✔ you have provided the original and the certified translation of the Course information form
✔ you have provided at least one completed form relating to your professional experience with contact details for
your supervisor (while studying or since graduating)
NOTE:
• Please do not staple any part of this applicatio .
• Please do not send parts of this application in separate plastic wallets or covers.
• For confirmation of safe receipt it is advisable to send the application by registered mail, so you will be able to track it.
For HCPC use only: Profession AA number Page
