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  • Practitioner Membership Application

    Practitioner Membership Application

Requirements for Practitioner Membership

  1.  The applicant must receive his / her professional education and training from a recognized education institution that holds accredited status with The Councils on Chiropractic Education International (CCEI) accrediting bodies at the time of graduation. CCEI accrediting bodies are:-
    1.1 Council on Chiropractic Education Australasia (CCEA)
    1.2 Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (CFCREAB)
    1.3 Council on Chiropractic Education United States of America (CCE)
    1.4 European Council in Chiropractic Education (ECCE)
  2.  The applicant must be licensed to practice Chiropractic:
    2.1 If the applicant is practicing in Malaysia, he / she must be registered with the Traditional and Complementary Medicine Council.
    2.2 If the applicant is practicing elsewhere, he / she must be registered with the statutory professional regulatory body of that country.
    2.3 If the applicant is practicing in a country where there is no professional regulation, he / she must be a member of the local chiropractic association which is recognized by the World Federation of Chiropractic (WFC).

Application Process and Fees

  1.  All sections of this application form, including the declaration must be completed.
  2.  Supporting documents to be submitted with a completed application form include:-
    2.1 Certified true copies of the chiropractic certificate issued by the institution you graduated from.
    2.2 Certified true copies of licenses issue by the licensing board of any jurisdiction where you have practiced.
    2.3 A letter of good standing from the licensing board of any jurisdiction where you have practiced.
    2.4 A letter of good standing from any chiropractic association which you have been a member of.
    2.5 Recent passport size photograph.
    2.6 Photocopy of your identification document (Identification Card for Malaysians and Passport for non-Malaysian).
  3. Application fee is waived for chiropractic graduates who join as regular member within one month from their graduation date.
  4. For applicants with prior practice experience or any application after one month from the graduation date:
    4.1 Payment of the application fee of RM500.00 must be made at the time of lodging an application; the application fee is not refundable.
    4.2 The applicant will be informed by email of the result of their application within one month.
    4.3 Upon approval, payment for the annual membership fee must be made to become a member of the Association.
    4.4 Upon approval of the membership application, the full payment of membership fee is required to be paid within two weeks . Failure to do so will result in the application being treated as withdrawn and the appropriate reapplication fees must be paid.
  5. The membership dues and fees shall be:
    5.1 Application Fee: RM500.00.
    5.2 Regular Membership: RM500.00 per annum.
    5.3 Student Membership: RM50.00 per annum.
    5.4 Non-Practicing Membership: RM300.00 per annum.
    5.5 Late Penalty: RM100.00.
    5.6 Reactivation Fees: RM200.00
  6.  Membership must be renewed annually before 31 December. Failure to renew their membership before 31 December may incur a late fee and result in automatic lapse of membership and corresponding loss of rights and privileges.
  7.  Payment method:
    7.1 Cash deposit or online transfer to ACM CIMB Account
    7.1.1 Account Name : Persatuan Kiropraktik Malaysia
    7.1.2 CIMB Account No. : 8002360559
  8.  For renewal and applications, the Association will only deal with the member / applicant directly; not with the company / employer.
  9.  Details on the deposit / transaction slip should include:-
    13.1 Amount of Deposit (RM) :
    13.2 Date of Deposit :
    13.3 Beneficiary Account No. :
    13.4 Cheque No. (only for cheque deposits) :
    13.5 Cheque Issuing Bank (only for cheque deposits) :
  10.  These conditions may change with amendments in policies and regulations of the Association.

Professional Indemnity Insurance

Please be informed that Doctor of Chiropractic in Malaysia are required to carry professional indemnity insurance as stipulated in code of ethics of both the Association of Chiropractic, Malaysia (ACM) and the Federation of Complementary & Natural Medical Association, Malaysia (FCNMAM).

This is the workflow regarding the MSIG Professional Liability Insurance

Scheme for Traditional and Complementary Medicine Practitioner in Malaysia for Chiropractors.

1. Only chiropractors who are holding an active ACM membership will be allowed to renew their MSIG Professional Liability Insurance Scheme for Traditional and Complementary Medicine Practitioner policy in Malaysia.

2. Those who are no longer registered as ACM members will not be permitted to renew.

3. ACM will be issuing the *certificate of membership* with the renewal period stated on it.

4. Every chiropractor is required to submit the *certificate of membership* to MSIG upon renewal of their policy.

If you have any further enquiries about professional indemnity insurance, please do not hesitate to contact us at .
  1. The personal data that is herewith collected by the Association of Chiropractic Malaysia is solely for the purpose of record-keeping and processing of your application for Membership into this Association. You may contact our Honorary Secretary for access to and for correction of your personal data.

  2. Name (as per Identification Card or Passport)*
    Please type your full name.
  3. Nationality*
    Invalid Input
  4. Identification Card No.*
    Invalid Input
  5. Passport No.*
    Invalid Input
  6. Issuing Country*
    Invalid Input
  7. Date of Issue*
    / / Invalid Input
  8. Date of Expiry*
    / / Invalid Input
  9. Gender*
    Please specify your position in the company
  10. Date of Birth*
    / / Invalid Input
  11. Ethnicity*
    Invalid Input
    As required by the Ministry of Health Malaysia (Kementerian Kesihatan Malaysia)
  12. Other ethnic groups:*
    Invalid Input
  13. Home Phone No.
    Invalid Input
  14. Mobile Phone No.*
    Invalid Input
  15. Office Phone No.
    Invalid Input
  16. Working Address*
    Invalid Input
  17. Correspondence Address*
    Invalid Input
  18. Practice Experience*
    Please select number of years. Choose 1 for experience less than a year or none.
    Please select number of years. Choose 1 for experience less than a year or none
    RM500 for Application Fee (One time)
    RM200 for Reactivation Fee
    RM500.00 for Regular Membership January-December
    RM250.00 for Regular Membership July-December
    RM300.00 for Non-Practicing Membership January-December
    RM150.00 for Non-Practicing Membership July-December
    (refer to Application Process and Fees Section 4)

  20. Type of Membership*

    Please specify your Type of Membership
  21. Membership Period*

    Please specify your Membership Period

  23. Chiropractic Programme Attended*
    Invalid Input
  24. Qualification*
    Please type your Primary Chiropractic Qualification
  25. Duration of Study*
    Invalid Input
  26. Date of Graduation*
    / / Invalid Input

  28. Institution Name
    Invalid Input
  29. Qualification
    Please type other Qualification
  30. Duration of Study
    Invalid Input
  31. Date of Graduation
    / / Invalid Input
    Invalid Input

  34. Country*
    Invalid Input
  35. State*
    Invalid Input
  36. State*
    Invalid Input
  37. Registration No.
    Invalid Input
  38. Registration No.*
    Invalid Input
  39. Date of Registered*
    / / Invalid Input
  40. Country
    Invalid Input
  41. State
    Invalid Input
  42. State
    Invalid Input
  43. Date of Registered
    / / Invalid Input
  44. Country
    Invalid Input
  45. State
    Invalid Input
  46. State
    Invalid Input
  47. Registration No.
    Invalid Input
  48. Date of Registered
    / / Invalid Input

  50. Country / State
    Invalid Input
  51. Company Name
    Please type other Qualification
  52. Period of Practice
    / Please select number of years and months
    Please select number of years and months
  53. Country / State
    Invalid Input
  54. Company Name
    Please type other Qualification
  55. Period of Practice
    / Please select number of years and months
    Please select number of years and months
  56. Country / State
    Invalid Input
  57. Company Name
    Please type other Qualification
  58. Period of Practice
    / Please select number of years and months
    Please select number of years and months
  59. Are you practicing chiropractic at the moment?*
    Invalid Input

  61. CCP Company Name
    Please type other Qualification
  62. Date of Commencement
    / / Invalid Input
  63. Practice Name & Address
    Invalid Input
  64. Do you provide after-hours / emergency care at your clinic?*
    Please specify if you provide after-hours / emergency care at your clinic
  65. Do you provide house visits?*
    Please specify you you provide house visits
  66. Are you covered by Professional Indemnity Insurance?*
    Invalid Input
  67. Please specify the period, insurance company and attach a copy of the policy
  68. Insurance Company*
    Invalid Input
  69. Beginning*
    Invalid Input
  70. Expiring*
    Invalid Input
  71. Upload copy of the policy (PDF)*
    Invalid Input
  72. Do you wish to buy Professional Indemnity Insurance coverage from MSIG?*
    Invalid Input
  73. ACM will send our agent to contact you to purchase your Professional Indemnity Insurance as soon as possible
  74. Please note your membership will not be processed without a Professional Indemnity Insurance

  75. Have you ever been disciplined by any professional association and / or licensing body?*
    Invalid Input
  76. Please specify*
    Invalid Input
  77. Have you had or are you aware of any malpractice claims against you?*
    Invalid Input
  78. Please specify*
    Invalid Input
  79. Have you ever been prosecuted from professional / malpractice claims / charges brought against you?*
    Invalid Input
  80. Please specify*
    Invalid Input
  81. Email*
    Invalid email address.
    You will be able to login to the site using this email as username after you will receive an activation link by email and after your account will be enabled by the administrator.
  82. Re-enter Email*
    Invalid email address. Email address must be the same as above.
  83. Password*
    Invalid Input
  84. Repeat Password*
    Try the same password as above.
  85. Identification Document*
    Invalid Input
    Identification Card / Passport - PDF maximum 5MB
  86. Passport Size Photo*
    Invalid Input
    PDF, maximum 5MB
  87. Certified true copy of chiropractic certificate*
    Invalid Input
    PDF maximum 5MB
  88. Certificated true copy of chiropractic license certificate
    Invalid Input
    PDF maximum 5MB
  89. Letter of good standing
    Invalid Input
    PDF maximum 5MB
  90. Application Fee
  91. Reactication Fee
  92. How would you like to pay your member fee?*
    Invalid Input
    to open a new window/tab to our secure online payment gateway at Billplz
  94. Please Upload Payment Proof*
    Invalid Input
    PDF maximum 5MB
  95. Do you want your email id and/or contact number to appear in the members’ details section of our website?*
    Invalid Input
    The email and/or phone number will be displayed in the "Find your Chiropractor" section
  96. Mobile Phone No.
    Invalid Input
    The phone number will be displayed in the "Find your Chiropractor" section

    I hereby apply for membership into the Association of Chiropractic Malaysia and agree to abide by the rules, bylaws, regulations, Code of Ethics, and Advertising guidelines adopted by the Association.

    I agree to uphold the principles of the Association, to assist in all ways to accomplish the Association’s objectives, and to pay and be liable for all dues and professional indemnity insurance premiums imposed by the Association in accordance with the Rules.

    I hereby declare that all the information that I have provided with this application is true. I understand that any misrepresentation of the information provided whether wilful or unintentional may result in my immediate dismissal from the Association of Chiropractic Malaysia and a formal report with recommendations to be made to relevant regulatory bodies.

  98. I sign the declaration above*
    You must agree with the declaration above.