Approved Clinicians &
Section 12(2) Doctors

Approved Clinician Change of Circumstances Form

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Please submit this form every time that your circumstances change.

Completion of this form is in addition to the legal requirement for you to complete a separate annual update form.

Update forms are required from Approved Clinicians on a once yearly basis as directed in the Mental Health Act 1983 Approved Clinicians (Wales) Directions 2018.

All questions marked with a * are mandatory

Personal Details

Please double check you've entered the correct email address

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Change of Circumstance

I have: *

Clinicians who are AC approved in England must apply for and receive approval from Wales AC Approval Panel for separate AC approval before undertaking any AC duties in Wales.

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New Employment Details

My new employment details to be entered onto the AC register are:

If your employment/work address is a private home address please indicate this on the form below and your details will be listed on the register as “c/o private address” and will not be released.

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Privacy Consent

This form collects personal information about you and we use this information to allow the All Wales Approval Team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Approved Clinicians &
Section 12(2) Doctors

Approved Clinician Change of Circumstances Form

Please submit this form every time that your circumstances change.

My new employment details to be entered onto the AC register are:

Privacy Consent