Axon Neuro associates

Join Axon Neuro as an associate

Complete this application and attach your photo and documents. It takes around 15 minutes. Our team will review it and be in touch. Your information is kept securely and used only to assess and set up your account.

Your details

First name *Last name *Email *Phone *Date of birth *Postcode *

Home address *Town / area shown to clients

Right to work and tax

National Insurance number *UTR (Unique Taxpayer Reference) *Right to work expiry date (leave blank if it does not expire)Trading status

DBS and safeguarding

DBS certificate number *DBS issue date *

Who does your DBS cover? *

AdultChildAdult and child

I am registered with the DBS Update ServiceI am cleared to work with vulnerable adultsI am HCPC-registered as a Psychologist, Speech and Language Therapist, Occupational Therapist or Physiotherapist, so a Level 2 safeguarding certificate is not required.

About you

Experience (e.g. years, level)Languages spoken

Short bio (shown to clients)

Professional memberships and HCPC

Please list any relevant professional memberships or HCPC registration, including membership numbers where applicable.

References

At least one reference is required. You can add up to 5.

Reference 1

Full name *Email *Company name *Contact number (optional)Their job title *Relationship to you *

I confirm I have the permission of the people named above to share their details with Axon Neuro as references. *

Rate and availability

Your hourly rate (GBP) *

Set your hourly rate to include all your travel costs, both your time and your mileage to and from visits.

Max travel distance (miles) *Minimum booking hours per day (optional)Insurance expiry date *

When are you available? *

Set the times you can usually work, in 15-minute steps (or switch to the time-range view). Clients book from exactly these times. This sets up your availability calendar, which you can change any time in your account once approved.

0 hrs/week

8:00am

8:15am

8:30am

8:45am

9:00am

9:15am

9:30am

9:45am

10:00am

10:15am

10:30am

10:45am

11:00am

11:15am

11:30am

11:45am

12:00pm

12:15pm

12:30pm

12:45pm

1:00pm

1:15pm

1:30pm

1:45pm

2:00pm

2:15pm

2:30pm

2:45pm

3:00pm

3:15pm

3:30pm

3:45pm

4:00pm

4:15pm

4:30pm

4:45pm

5:00pm

5:15pm

5:30pm

5:45pm

6:00pm

6:15pm

6:30pm

6:45pm

7:00pm

7:15pm

7:30pm

7:45pm

8:00pm

8:15pm

8:30pm

8:45pm

Tap or drag to select. Each cell is 15 minutes.

Documents

Photo up to 5MB; documents up to 10MB each. Images or PDF.

Photo of yourself (for your profile card)Photo ID (passport or driving licence) *Proof of right to work in the UK *Proof of address *Enhanced DBS certificate (front of page) *Enhanced DBS certificate (back of page) *Level 2 safeguarding certificate(s) *Insurance certificate (Public Liability / Professional Indemnity) *CV *Qualification certificate (optional)First aid certificate (optional)

Driving (optional)

Driving is optional. If you drive for work, share your details so clients who need a driver can be matched to you.

I drive and have my own vehicle

To share your driving record, get a DVLA check code at gov.uk/view-driving-licence, then come back and enter the code below.

DVLA check code (optional)

Driving licence (optional)Business insurance for driving (optional)

Consent