BSCAH

British Society of Clinical & Academic Hypnosis

Constituent Society of the European and International Societies of Hypnosis

Incorporating the British Society of Medical & Dental Hypnosis (BSMDH) founded 1952

and the British Society of Experimental & Clinical Hypnosis (BSECH) founded 1977

Application to obtain Accreditation

from a Sheffield, UCL or Stafford Diploma

Those members of BSCAH with the Diploma from Sheffield, UCL or Staffordshire University can, at the discretion of the Academic and Accreditation committee, be awarded Accreditation, upon receipt of evidence of clinical usage and a fee of £25. Final ratification may, in exceptional circumstances, require that an applicant attends a meeting of the Committee.

If you wish to be on the BSCAH Referral list you are expected to maintain a level of continuing postgraduate development in hypnosis. This currently should total thirty hours certified attendance at appropriate courses over any five year period. You would also be required to document evidence of supervision.

Please complete this form and send electronically to Dr Peter Naish at natoffice@bscah.co.uk. Please also send a cheque for £25 (made payable to BSCAH) to BSCAH National Office c/o Hollybank House, Lees Rd, Mossley. OL5 0PL.

Full Name (Dr / Miss / Mr / Mrs / Ms)
Full Postal Address
Contact Telephone Number
Professional Qualifications
Present job or speciality
Date of Diploma & Awarding Body

Conversion Application – Conversion – Page 2

Clinical usage of hypnosis since Diploma:
Personal referee: (This could be a tutor who knows you from the Diploma course)
I wish to apply for BSCAH Accreditation Signature: Date: Do you wish to be on the BSCAH referral list? YES NO If YES please complete the sections below:
What are your arrangements for supervision? What form and frequency?
Name and qualifications of supervisor:
Do you have someone whom you can contact for supervision in an emergency?
CPD requirement You can enter your CPD when you access ‘Update your details’ after logging into the member’s section of the website. Alternatively you may record your CPD in the form below. Teaching or giving a talk should be weighted by awarding double hours Presenting a paper should count as 2 hours Publishing a paper should count as 4 hours Non BSCAH, BSMDH (Scotland), RSM Section, ESH or ISH meetings may be included with prior approval by Ac & Ac. In such cases the programme and a short description of the content should be submitted to Ac & Ac.
Conversion Application – Conversion – Page 3 Someone who has problems attending meetings can give details of other submissions such as publishing e.g. a book, chapter of a book, taking part in a teleconference or webinar, or relevant reading, which will then be considered by Ac & Ac on a case by case basis Applicants will be required to provide a verifiable record of CPD on application so please keep all certificates of attendance Date Name of Course Organised by Hours claimed Speakers Notes – what I have learnt from this
Please give details of your current indemnity insurance
Please sign the commitments below – I confirm that I have no disciplinary findings or complaints outstanding Yes No (Please circle relevant response and provide details if responding No) I confirm that I have no criminal record and no record of any police cautions Yes No (Please circle relevant response and provide details if responding No) I undertake to practice hypnosis only for the purpose for which I am professionally qualified and within the strict limitations of my professional work. I have completed the CPD and the supervision requirement Signature: Date: