Healthcare providers (or current students) that would like to apply to become Certified Clinical Trigger Point Therapist must first submit the application below. We must have a picture identification for all applicants. You can either scan your picture I.D. (such as a driver's license) and use the upload button below to submit it digitally, or you may mail a photocopy of it to the address below. We also must have proof that you are a licensed healthcare provider in your state or country. Preferably this should be a digital scan or photocopy of your license or diploma, and you can either upload it below, or mail it to us along with your Picture I.D. if you so choose. If you are currently a student, please provide contact information for your school director so that we can verify your enrollment.

Mailing Address:
Dr. Perry
17043 El Camino Real Dr.
Suite#: 201
Houston, TX 77058

Once your application has been submitted, we will confirm your information and contact you with details on the next step in the certification process.
Thank you.

Type of Application Application for Certification

*Last Name

*First Name

*Email Address

*Phone Number:

*Address
(street, unit, city/town, state/province, zip code, country)

Please submit a Picture I.D.
(This can be a scanned copy of your driver license or other state I.D. card with your picture and name on it.)

I choose to mail a photocopy of my Picture I.D.

Please submit a copy of your Healthcare Profession license, certificate, or diploma.
(Examples: State Massage License, State Physical Therapy License, etc)

I choose to mail a photocopy of my Healthcare Profession license.

If you are a current student in a healthcare field, please provide the name of the school you are attending, the name of its directory, and a phone number for the school or director.

*Required