DermExcel™ | Practice Registration – Dermalhealthpractice™

Step 1 · Your practice

Let's start with the basics

Practice name

Country

Province

City / town

Practice phone

Website (optional — helps us get to know you faster)

Instagram (optional)

Step 2 · Clinical leadership

Who leads the clinical side of your practice?

Step 3 · Verification

Help us verify quickly

Qualification / registration certificate (image or PDF — speeds approval) + Add documents

Up to 5 files, 8 MB each.

What treatments / services does your practice offer?>

Other medical skincare brands you stock (if any)

Step 4 · Business details

For your stockist account

Registered company name

VAT number (if applicable)

Street address

Suburb

Postal code

Accounts contact (optional — we can set this up later)

Name

Email

Phone

Step 5 · You

Almost done

Title

First name

Last name

Email

Mobile

As the owner of this practice, I confirm the information in this application is accurate and complete.

Type your full name as signature

✓

Application received — reference

Thank you. Our team reviews every application personally — you'll hear from us within two business days at the email you provided.

✓

You're on the list.

We've kept your details. The moment you partner with a regular practitioner, reply to our welcome email and you'll be fast-tracked — no need to start over.

Medical practice application