Register as ClientClient registration formPersonal detailsFirst Name*Last Name*E-mail*Password*Confirm Password*Mobile No.*Date of BirthReferral Source*My EmployerOnline SearchTherapy RouteFriendMy current therapistEmployer paying for your sessions*Headroom's Terms of Use*I have read and here-by accept the terms of Headroom's Client Agreement, Privacy Policy, Acceptable Use Policy and the provisions of POPIA & PAIA Manual.Communications*I consent to receive ad-hoc client communications, newsletters and special offers from Headroom. I understand I can subscribe at any time.GenderMaleFemaleCity*Emergency Contact NameEmergency Contact No.Medical aid detailsMedical Aid Communications ConsentI hereby grant Headroom permission to communicate directly with my medical aid in case of queries. I acknowledge that the responsibility to submit my claims is mine.Medical Aid Membership No.Medical Aid NameDependent Code Only fill in if you are not human Login Client Agreement