Pearson Clinical Assessment Registration Form

Please complete this registration form if you are a first time customer of Pearson Clinical Assessment.

Country

For other countries please visit our global directory for your country's Clinical Assessment contact details.

First Name

Last Name

What type of account would you like to set up for ordering?

Organization (Business account) Individual (For yourself)

Organization Name

Max. 80 characters

Role

Role Detail

Street Address / Number

Apartment / Suite / Floor (optional)

Building / Other Address Identifier (optional)

City

Clinical Interests

Children (Under 10)	Adolescent (10-18)	Young Adult (19-35)
Adult (36-60)	Older Adult (60+)

Qualifications - Similar to our product levels, all website customers are assigned an individual qualification level of A, B, or C to allow for purchasing of corresponding assessments. Complete one or more of the sections to be assigned a qualification level. You may update your qualifications at any time.

Degree

License/Certification

Organisation/Association membership

I would like to receive the latest product and services information from Pearson

Yes

I certify that the details supplied are correct to the best of my knowledge and I will immediately notify Pearson of any changes that may affect my qualification to purchase. I agree to protect clients and the integrity of restricted publications by ensuring that they are not used by unauthorized persons. I have read and hereby agree to abide by Pearson Assessment's Terms and Conditions of Sales. I agree I will not resell any restricted Pearson Assessment products.

Yes

DATA PROTECTION ACT
Your personal data will be processed by Pearson Clinical Assessment, part of Pearson Education South Asia Pte Ltd in accordance with the Data Protection Act and our privacy policy.

I agree and consent to the disclosures above.

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