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Full name: *

Please enter your full name

Title: *

Please select your title

Gender: *

Please select your gender

Age: *

Please tell us your age

Contact Email : *

Please enter your primary email address. This will be the email address used to contact you throughout the CISMA process. Please ensure that cisma@cf.ac.uk is not on your spam or junk list.

Re-type Contact Email : *

Please re-enter your primary email address.

Alternative email address: *

If you have a secondary email address (e.g. a personal email address), please enter it here. This will only be used if there are problems contacting you via your primary email address.

How did you hear about CISMA?: *

How did you hear about CISMA - Other:

If you ticked "Other", please state how you heard about CISMA

Recommendation / email / link from professional organisation:

If you were alerted to the CISMA project via a professional organisation, please state the name of the organisation

Profession: *

Please enter your Profession

Profession - Other:

If you selected 'Other' above, please tell us your profession here

Length of time working in your Profession: *

Please enter how many years you have been working in your profession

Grade: *

Please enter your grade, eg. Consultant, Registrar, band 7, ESP, Lecturer, etc.

Percentage of your current clinical caseload which comprises shoulder pain patients : *

Please state what percentage of your current clinical caseload is comprised of shoulder pain patients. If you do not work clinically, please write n/a

Please state your qualifications: *

E.g. DipPT, BSc, MSc, MPhil, PhD, MD, MBBS, FRCS, etc

Have you undertaken any specialist training in movement analysis?: *

Please detail any specialist training, e.g. Kinetic control courses, MSc in biomechanics, etc.

Are you a member of any specialist interest groups/associations?: *

Eg. British Elbow and Shoulder Society, MACP, ACPSM, EUSSER, ASSET

Nature of Work: *

Please enter the nature of your work

Nature of Work - Other/Combination:

If you selected 'Other/Combination', please enter the details here, eg. 50% NHS 50% Private

Name of Trust /Company /Organisation: *

Please enter the name of the trust, company and/or organisation you work for

Are you based in the UK?: *

For your shoulder related work (clinical or research) are you predominantly based in the UK?

Geographical Location (UK):

If you are based in the UK, please select the county that best describes where you work

Geographical Location (Other):

If you are not based in the UK, please select the country that best describes where you work

Was your professional degree taught in English?: *

Is English the language you use in your clinical practice?: *

Other language:

If your Professional degree was taught in a language other than English and/or you use a language other than English in your clinical practice, please state the language that you were taught in/use.

Clinical Speciality: *

Please select your clinical speciality/specialities.
Please note that here we are asking for the type of patient(s) that you typically treat / manage.

Clinical Speciality - Other/Combination:

If you selected 'Other, please enter your clinical speciality/combination

Professional Registering Body : *

Please enter the name of your professional registration body, e.g. HPC (Health Professions Council), GMC (General Medical Council), etc.
If you are not registered in the UK, please state the name of your national, professional regulatory body

Professional Registration Number : *

Conditions of Registration: *

I agree to the terms laid out below and wish to register with CISMA

I confirm that the details I have provided are correct.
I consent to the CISMA team checking my details against the databases of the relevant professional registration body in order to confirm my current professional status.
I will not divulge to anyone details of my password used to access the CISMA website nor will allow anyone not registered with CISMA to view the site
I will not access or view the clinical videos on the CISMA site for any purpose that the CISMA research process or education
I will not reproduce any content from the CISMA website without express written permission from CISMA
In the unlikely event that I recognise anyone on the clinical videos, I will not divulge their personal or clinical details

Within the next 2 working days you should receive an email from cisma@cardiff.ac.uk with your CISMA username and password. If you do not receive this email please use the "Contact us" form on the CISMA website to let us know because the email may have been blocked by your email system. Thank you.

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