Want to become a stockist?
Thank you for your interest in becoming a stockist, so we can deal with your unique enquiry appropriately please submit your answers below and a member of our team will be in contact with details and options available to you shorty.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Business Website or Social Media Handle
*
Preferred Contact Method
*
(email, phone, whatsapp)
Professional Registration Number & Type
*
(e.g NMC/GMC/GDC/NVQ)
Do you have a Church Pharmacy account?
*
Training Preference
*
(1:1 IN CLINIC, GROUP, ONLINE)
Preferred Training Day(s)
*
MON-FRI weekends on request and availability
Clinic Set Up
*
HOME CLINIC, ROOM RENTAL, FULL CLINIC PREMISES
No. of Team Members
*
How many patients do you see in a week?
*
What skin concerns are your patients presenting?
*
Are you interested in retailing skincare products?
*
Any additional comments:
Submit
Should be Empty: