Please complete form below.


Become a practitioner Form

All fields marked with * are mandatory.

IMPORTANT – Should the form not be signed in full, the application will be void

    Applicant Information


    Please upload your headshot or logo for your listing on our website

    Max Size: 32MB | Format: jpg, png, pdf

    Dispensing License?


    Date of Birth:*

    Where did you hear about us?

    Were you referred by a fellow doctor?

    If yes, who was your referring doctor?

    What information do you want customers to see on the Slender Wonder website?

    Education & Occupation




    I certify that my answers are true and complete to the best of my knowledge. I understand that it is at the sole discretion of Slender Wonder TM to accept my application, or revoke my status as a Slender Wonder TM Practitioner.

    Protection of Personal Information Act (POPI Act) - POPIA

    I hereby consent to the personal information provided by me to be used for delivery of services offered by Slender Wonder.
    It is my legal obligation to provide correct information in the contracting with Slender Wonder and where such information has been changed, I am obliged to inform
    Slender Wonder accordingly.
    I am aware that I can unsubscribe to any newsletters, campaigns, communications from Slender Wonder by notifying them accordingly.
    It is my right to request Slender Wonder to delete and cease to use any of my personal information subject to any legal obligation on Slender Wonder’s side to keep same.
    There is a legal obligation for Slender Wonder to retain your information for 5-years from date of contracting, whereafter it will be destroyed in a POPIA compliant
    Should I believe that there has been a misuse of my personal information, I am aware that I can lodge a complaint with Slender Wonder and / or the Information Regulator at


    Printed Name*

    NOTE - Please use your mouse or trackpad to create your signature

    Practitioner signature*

    (IMPORTANT - Should the form not be signed in full, OR, a full signature uploaded the order will be void)

    NOTE - Please upload your signature

    Formats (JPEG, PNG, PDF)