HPCSA Registration Form

Title*

First Name*

Last Name*

E-mail Address*

Confirm E-mail Address*

Phone Number

Password*

Confirm Password*

Confirm Professional Council Registered with*

Profession*

Select Biokineticist profession*

Select Clinical Technologist profession*

Select Counsellor profession*

Select Dental profession*

Select Electro Encephalographic Technician (EE) profession*

Select Emergency Care profession*

Select Environmental Health profession*

Select Hearing Aid Acoustician profession*

Select Laboratory Assistant (LA) profession*

Select Medical Laboratory Scientist (MLS) profession*

Select Medical Orthotics and Prosthetics profession*

Select Medical Technician (GT) profession*

Select Medical Technician (Supplementary) - SGT profession*

Select Medical Technologist (MT) profession*

Select Nutritionist profession*

Select Occupational Specialist profession*

Select Optometrist profession*

Select Paediatric profession*

Select Physician profession*

Select Physiotherapist profession*

Select Psychologist profession*

Select Radiographer profession*

Select Speech Therapist profession*

Select Surgeon profession*

Select Therapist profession*

Professional Council Number*

City*

Guidelines for a strong password:

At least 8 characters—the more characters, the better.
A mixture of both uppercase and lowercase letters and a mixture of letters and numbers.
Inclusion of at least one special character, e.g. ,! @ ? ]#

Only fill in if you are not human