Javascript is disabled on your browser and this site won't work properly without Javascript enabled.
Therapist Insurance :: KlaptonOnline
Buy your policy online today Get a quote
Therapist Insurance Application Form
Note: * Indicates required field.

Applicant Information

Requested Third Party and Professional Indemnity Insurance Limits and Deductible

Limit Per Claim* :
Deductible Per Claimant* :

Applicant Information

Insured Information

Use the Applicant's name and address

Insured Business Name

Business and/or corporate name to be included in the Name of Insured.

The policy will show the insured's name, which will include the name of the owner (applicant), the corporate name and trading name. This is in order to provide coverage for your business, as well as yourself.

Professional Information

Choose the group where your practice is listed*. If any of your practices appears in more than one group, choose the higher group (A is lower risk, and C is the highest risk)

A B C
  • ABA Therapist (Applied Behaviour Analysis)
  • Acu-yoga
  • Acupressure (including seated Acupressure)
  • Alexander Technique
  • Amatsu Therapist
  • Ancient Balinese Body Palming Massage
  • Anma and Seitai
  • Aromatherapy & Aromatherapy Massage
  • Art Therapy
  • Aqua-Fit
  • Aqua Massage Using AMI Equipment
  • Auricular Ear Therapy (Hopi Ear Candling) (Multinational practice allowed)
  • Auriculotherapy
  • Autogenic Training
  • Balance Training
  • Bio Energy Practitioners
  • Bonnie Prudden Myotherapy
  • Bowen Technique
  • Career Counsellor
  • Chair Massage/Seated Massage
  • Chakras Therapy
  • Champissage
  • Clothed Massage
  • Colour Analysis/Therapy/Chromotherapy/Colorology
  • Complementary Therapist
  • Corrective Therapist
  • Counsellor Educator
  • CranioSacral Therapy
  • Creative Workshops
  • Crystal Sounds/Crystal Therapy
  • Cultural Bodywork
  • Cupping including Hijama
  • Dancing/Dance Movement Therapy
  • Daoyin Tao
  • Dog Grooming
  • Drama Therapy
  • Dream Therapy
  • Eastern Facial Massage
  • EMF Balancing Technique
  • Emmett Technique
  • Emotional Freedom Technique
  • Enar Therapy
  • Energy Emission Analysis
  • Energy Medicine
  • Energy Psychology
  • Energy Therapy (including EFT)
  • Energy Work
  • Energy Works Instructor
  • Energy/Space Clearing
  • Equine Massage Therapy
  • Esalen Massage
  • Esthetics with Massage Therapy
  • Faradic Treatments
  • Fendenkrais
  • Feng Shui
  • Five Element Shiatsu
  • Floatation Therapy
  • Foot Health Practitioner
  • Galvanic Treatments
  • Hands Massage
  • Hands-Free Massage
  • Hari
  • Hawaiian Lomi Lomi Massage
  • Herbalists/Herbal Medicine/Herbal Therapy
  • Holistic Nutritional Therapist
  • Holistic Practitioner
  • Holistic Pulsing
  • Holistic Therapist
  • Homeopathy
  • Horstmann Technique
  • Indian Head Massage
  • Intro Sound Therapy
  • Intuitive Healing
  • Intuitive Movement
  • Ionic Foot Detox Spa
  • Kenkujutsu
  • Ki Therapy
  • Kinesiology
  • La Stone Therapy
  • Life & Business Coach
  • Mace Method
  • Magnet Therapy
  • Mana Therapy
  • Massage
  • Massotherapy
  • Medical Massage
  • Mehndi Henna
  • Melchizedek Method
  • Metamorphic Technique
  • Millia Removal
  • Miwi Therapy
  • Mobile Massage
  • Mobile Sports Massage
  • Moxa
  • Muscle Activation Technique (MAT)
  • Muscle Energy Technique
  • Muscle Release Technique
  • Music Therapy
  • Myofacial Release 
  • Naikan
  • Natural Lift Facial Massage (Facial Rejuvenation Massage)
  • Naturopathy
  • Neuromuscular Therapy
  • NLP
  • Nutritional Consultant
  • Nutritional Consultant for Animals
  • Nutritional Therapy
  • Occupational Therapist/Therapy
  • Occupational Therapist Assistant
  • Oil Massage
  • Oriental Face Massage
  • Orthopaedic Massage
  • Oscillation Therapy
  • Osteopathy
  • Oxygen Therapy
  • Paraffin Wax
  • Pellowah Healing
  • Pet Therapy
  • Physical Therapist Assistant
  • Physical Therapy (Physiotherapy)
  • Play Therapy
  • Pneuma Therapy
  • PNF Stretching
  • Polarity Therapy
  • Pulsed Magnetic Therapy
  • Qi Therapy
  • Qigong
  • Quantum Touch
  • Raindrop Therapy
  • Raynor Massage
  • Reflexology
  • Reiki
  • Rejuvi
  • Remedial Massage
  • Remedial Massage Therapy
  • Rolfing (Structural Integration)
  • Rosen Method Practitioner
  • Sand Tray Therapy
  • Sclerotherapy
  • Sekhem
  • Sekhem-Seichim-Reiki
  • Shamanic Healing
  • Shiatsu
  • Shindenjustu
  • Skeletal Balancing
  • Smoking Cessation Counselling
  • Sport Massage
  • Sports Therapist
  • Sports Therapy
  • Student Therapist
  • Swedish Massage
  • Sytemic Therapy
  • Tai Chi
  • Taihenjustu
  • Tens Therapy
  • Thai Foot Massage
  • Thai Massage
  • Thalassotherapy
  • Theraflex
  • Therapeutic Touch
  • Theta Healing
  • Touch For Health
  • Trager Approach / Trager Mentastics
  • Trigger Point Reduction / Therapy Tui-Na
  • Vibration Therapy (Colour, Light, Sound Therapy Only)
  • Watsu
  • Web-based Sound Therapy
  • Workshops in Women's Safety & Empowerment
  • Zero Balancing

  • Acupuncture (Auricular & Low level Laser Acupuncture)
  • Ashiatsu & Ashiatsu Oriental Bar Therapy
  • Ayurveda - Indian Health Care/Ayurvedic Massage
  • Baby Massage
  • Bach Flower Remedies
  • Body Electrical/Body Massage/Body Wrapping
  • Canine Bowen Technique/Massage Therapy
  • Canine Hydrotherapy
  • Collagen Red Light Therapy
  • Colorpuncture (Esogetics)
  • Connective Tissue Massage/Bindegewebsmassage
  • Deep Tissue Massage (Painless)
  • Electric-Stimulated Acupuncture (Electro-Stim)
  • Electro Magnetic Stimulation
  • Electro-Crystal Therapy (EleCT)
  • ElectroCrystals
  • E-Loss (Electro Optical Synergy Hair Removal)
  • Heat Treatments
  • High Frequency Treatments
  • Hopi Candle Therapy
  • Hydrotherapy
  • Hypnotherapy (multinational practice allowed)
  • Infrared Sauna/Cabin
  • Infrared Treatments Including Far Infrared Cabin
  • Intraceuticals Facial Infusion
  • Japanese Natual Medicine
  • Laser Lipolysis & Suction
  • Low Level Laser (Cold Laser)
  • Lymphatic Drainage Massage
  • Martial Arts Therapy
  • Micro-Current Treatments
  • Non-Invasive Breast Lift
  • Orthopractics
  • Sauna and Steam
  • Soft Tissue Massage
  • Soft Tissue Release
  • Tattoo Covers
  • Tattoo Removal (Not Surgical)
  • Ultrasound 1-3 mhz for Therapeutic Treatment
  • Western Medical Acupuncture
  • AHA/BHA Facial Peels
  • Alpha-Hydeoxyl Acid (Less than 25% Strength)
  • Chiropractic Acupuncture
  • Equine Assisted Coaching
  • Laser Tattoo & Hair Removal
  • Tattoo Removal (ND:YAG Laser System)

*If your trade does not appear in the list, please refer to our team for a personal quote.

Coverage Extensions

Occurrence Retroactive Date Coverage for the following previous period:

Claim Made Date Coverage for the following future period:

Coverage and include additional professionals/practitioners to this cover:

Coverage and include additional administrative employees to this cover:

Acknowledgement and Declarations

I hereby declare that within the last 5 years:

I had not been revoked, suspended, refused, cancelled or voluntarily surrendered any of the following:

  1. State license, certification or registration
  2. Malpractice insurance
  3. Public liability insurance

No claim or suit for alleged malpractice or public liability has been brought against me and I am not aware of any incident that might reasonably lead to such claim or suit. I have never been convicted (as an adult) of a felony and there isn’t any such case pending. No complaints or charges were brought against me by any licensing board or professional ethics body.

I hereby confirm that I have read and agree with the above statement.

I, the undersigned declare that all answers in this application form are complete and accurate. I understand completely that the answers provided are the basis for the provision of Insurance Cover. Furthermore, I declare that I do not have any supplementary information, in respect of this application, which could influence the outcome of your decision regarding my application request. My signature warrants that my application is submitted in all good faith.

I hereby confirm that I have read and agree with the above statement and it applies both to me and to any additional professional/practitioner and administrative employee included in this application.

Premium Payment Information: I hereby confirm that I understand that after completing and submitting this application form, I must pay the required premium before any cover will become effective.

Submitted Date: 16 Sep 2019