Fenton Green Insurance

Income Details

Total Annual Income

Number of practitioners (including yourself):

Are any of the above staff students?

Yes No

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Are you a member of an association?

Yes No

Please select the practitioners primary association of which they belong to

Please Note: If you are obtaining health fund provider numbers through AMT, the minimum requirement for professional indemnity insurance is $2,000,000 and $10,000,000 for public liability

Do you authorise Fenton Green Pty Ltd, to provide your policy documents to the Association of Massage Therapists (AMT)?

Yes No

Please Note: the AHA now require that you hold a minimum $10,000,000 professional indemnity limit and $20,000,000 Public Liability.

Please provide the Association name

Yes

Do you perform any other activities other than below listed AMT Recognised Modalities?

Massage therapy (includes Therapeutic, Relaxation, Swedish, corporate, Indian Head massage)
Remedial/deep tissue massage (includes connective tissue, muscle energy techniques, myofascial release, trigger point, joint mobilisation, Onsen, Orthobionomy)
Taping (includes, functional, sports, Kinesio)
Stretch, strength, conditioning and movement therapy (including Pilates, Yoga, Wu Tao, Ai Chi, Alexander Technique, Qi Gong, Gyrotonics, Gyrokinesis, Spiral Dynamic, Rolf Movement, Yogalates)
Structural integration (includes Rolfing, Feldenkreis, Hellerwork, Functional, Anatomy Trains. KMI)
Lymphatic drainage (includes manual lymph drainage,)
Oriental massage (includes Shiatsu, Watsu, Zen Shiatsu, Tui Na, acupressure)
Thermotherapy (includes cold/hot stone massage, moxibustion)
Electrotherapy (includes ENAR, SCENAR, TENS, IFAS)

Reflexology
Bowen Therapy (includes Emmett Technique, neurostructural integration, fascial kinetics)
Instrument assisted soft tissue release (includes cupping, gua sha, RockBlades)
Aromatherapy
Somatic therapy (includes somatic therapy, somatic experiencing and somatic integration)
Dry Needling
Craniosacral therapy (includes craniofascial)
Infant massage
Oncology Massage
Pregnancy massage
Myotherapy
Pain Education
Mobilisation of the nervous system

Select your Modalities from the list below

Do you work with any celebrities?

Do you work with any professional sports people or athletes?

In relation to working with professional sports people of athletes:

Do you work under the direction or control of the a doctor of physio?

Are you involved in treating of injuries or providing any diagnosis?

Please provide the percentage of income earnt from services provided to professional sports people, athletes or celebrities.

Please provide further details:

Business Details

Employee Numbers

State

Association

Modalities