Professional Declaration and Attestation

You declare that:

• You hold a current, valid, unrestricted professional licence from a recognised regulatory authority
• Your licence is in active good standing with no suspensions, revocations, restrictions, or probations
• You have the legal authority to practice your discipline in the jurisdiction(s) where you intend to serve
• You maintain responsibility for keeping your licence current and renewed

You declare that:

• You possess the minimum educational qualification required for your profession (Bachelor's, Master's, Doctorate, or recognised equivalent)
• All educational credentials were obtained from accredited institutions
• Your educational background aligns with your declared professional discipline and practice areas
• You maintain clinical competency appropriate to your scope of practice

You declare that:

• You adhere to your professional code of ethics and conduct standards
• You understand and accept ethical obligations including patient confidentiality, informed consent, patient safety, and non-discrimination
• You maintain professional boundaries and act with integrity in all clinical interactions
• You do not engage in fraud, deception, misrepresentation, or other unethical practices
• You maintain professional reputation consistent with your registration information

You declare that:

• You are not impaired by alcohol, illegal drugs, prescription medications, or controlled substances that would affect your ability to practice safely
• You are fit to practice your profession and free from conditions that would compromise clinical judgment or patient safety
• You have no history of disciplinary action, regulatory investigation, or professional sanctions
• You have no pending or unresolved malpractice claims, lawsuits, or regulatory complaints
• You maintain professional liability insurance appropriate to your practice scope

You declare that:

• You will practice only within the scope authorised by your professional licence
• You will not diagnose, treat, prescribe, or otherwise practice outside your licensed scope
• You understand that telemedicine does not expand or modify your legal scope of practice
• You will immediately refer patients to appropriate providers when clinical needs fall outside your scope
• You remain responsible for staying current with regulations in all jurisdictions where you practice
• You acknowledge that practicing outside your scope may violate professional licensing standards and harm patients

You declare that:

• All information you provided in your registration profile is truthful, accurate, and complete
• You have disclosed all material information that could affect credentialing or patient safety decisions
• You have not omitted, misrepresented, or falsified any information
• Any documents you provided (licences, certificates, proof of education, government ID) are authentic, unaltered, and verifiable
• You take full responsibility for the accuracy of all professional information in your profile
• You understand that providing false information may result in immediate account termination and legal consequences

You understand and consent that Thera Nexa Private Limited may:

• Verify your credentials through primary source verification with regulatory boards, educational institutions, and national practitioner databases
• Contact your professional licensing board, previous employers, and professional references as needed
• Conduct background checks and review public disciplinary records
• Access and review relevant healthcare regulatory databases
• Perform follow-up verification and credential audits at any time
• Request supplemental documentation or clarification during the verification process
• Share credential verification results with relevant healthcare authorities if required by law

You acknowledge and commit that you will maintain your professional licence and credentials in active good standing throughout your engagement with Connect Therapies.

You will immediately notify Thera Nexa (within 24 hours) of any material change, including:

• any suspension, restriction, revocation, or probation of your professional licence
• any regulatory investigation, complaint, warning, citation, or disciplinary action initiated by your licensing board
• any malpractice claim, lawsuit, settlement, or adverse judgment
• any criminal charge, arrest, or conviction
• any change in your physical or mental health affecting your ability to practice
• any other material change to information in your registration profile

Failure to immediately disclose material changes is grounds for account suspension or permanent termination. You agree to annual re-attestation of your professional credentials and will provide updated proof of licensure when requested. Thera Nexa has the right to audit and re-verify your credentials at any time during your engagement.

You understand that false statements, omissions, material misrepresentation, or fraud in this Declaration may result in:

• Immediate and permanent revocation of your platform privileges
• Termination of all sessions and removal from the therapist directory
• Reporting to your professional licensing board and regulatory authorities
• Civil liability for damages incurred by Thera Nexa or its patients due to fraudulent credentialing
• Criminal prosecution for fraud, perjury, or making false statements to a healthcare platform
• Cooperation with law enforcement investigations
• Inclusion in professional misconduct databases and registries
• Potential financial penalties and civil damages as permitted by applicable law

You authorise Thera Nexa to:

• Report any substantiated professional misconduct to your licensing board or regulatory authority
• Cooperate fully with regulatory investigations and audits
• Disclose your credentialing information to healthcare authorities when required by law
• Communicate with public databases used for provider verification
• Share relevant compliance information with healthcare insurance networks and third-party credentialing organisations

You acknowledge that:

• This Declaration constitutes a binding legal agreement
• You are legally capable of entering into this agreement and not under any mental incapacity that would prevent you from practicing
• The information is provided of your own free will without coercion or duress
• You have had the opportunity to seek legal or professional counsel before accepting this Declaration
• You understand the legal consequences of false statements and material misrepresentation
• You take full personal responsibility for the truthfulness and completeness of all information provided
• Thera Nexa's verification of your credentials does not relieve you of responsibility for maintaining accurate information
• You consent to this Declaration being maintained as a legal record

Thera Nexa may, in the future, implement a detailed credentialing form requesting specific documentation including:

• Professional licence numbers and issuing bodies
• Educational institution details and graduation documents
• Professional examination scores and certification credentials
• Disclosure of any adverse disciplinary or legal history
• Additional professional references and verification documents

This detailed credentialing will be offered as an optional enhancement to provide more comprehensive credential verification and advanced compliance features. You are not required to complete the detailed form to maintain your existing practitioner status. However, those who do complete the detailed form may receive enhanced verification status, priority platform features, or improved visibility when such enhancements are implemented.

For questions or concerns about this Professional Declaration, contact:

Thera Nexa Private Limited

Compliance Officer: ct.support@theranexa.co.in

Medical/Clinical Director: Available through the Connect Therapies Professional Portal