Information Form
Public Homeopath Directory

As a member of the Ontario Homeopathic Medical Association (OHMA) you are entitled to be listed on our Public Homeopath Directory. If you are a new member, and wish to be included, please complete the information in the form below and allow at least 48 business hours for your information to be migrated to the directory. Please note that the form will not go through without your portrait photo. The photo should be high resolution and the maximum size allowable is 5MB. If you do not wish to be included in the directory, please ignore this form.

IMPORTANT: If work from home and do not want your home address to show in the directory, please do not fill your address in here.

FOR RENEWING MEMBERS: You can use this form to update your existing information, or ignore it if your information is already complete and up-to-date.

Name*
First Last
Address
Street Address Address Line 2 City Province Postal Code
Phone Number*
Email*
Website
Name of Company/Clinic (if applicable)
Year Company/Clinic was Established (if applicable)
Clinic Hours (if applicable)
Your Professional Qualifications*
About You*
Portrait Photo Here Please*
Accepted file types: jpg, png, , Max. file size: 5 MB.
The information will not go through unless there is a photo attached to this form.

Information Form Public Homeopath Directory

Title

Information Form
Public Homeopath Directory