Register as an adult

Please complete the registration form below, to let us help you in the best way.

I agree with the terms and conditions*
Adult Last Name*
Adult First Name*
Adult Nationality*
Adult Date of Birth*
Adult Gender*
Adult Email
Adult phone:
Address for Invoice*
Do you live at the address above:*
Home Address:*
We would like to know your employer's name for our statistical purposes.  We sometimes contact companies to ask for funding and it helps us to be able to show how often our services have been used.  We NEVER share names of clients or personal data and all your information is treated with complete confidentiality. 
Adult Employer's company
Name of Practitioners that you will use, if known:
Please tell us how you found us:
Confidential notes you may wish to note now to help us:
Word Verification:

Contact us

+41 44 548 23 35

Schwäntenmos 4
8126 Zumikon