Prologic Skincare Stockist Application Form
Name
*
First Name
Last Name
Mobile Number
*
-
Area Code
Phone Number
Clinic E-mail
*
example@example.com
Clinic Name
*
Clinic Address
*
Street Address
Street Address Line 2
Town/City
County
Postcode
Clinic Website or Social Media Handle
*
Please tell us why you would like to become a Prologic Skincare Stockist? If you are a practicing Corneotherapist your application will be prioritised subject to our radius clause being available in your area
*
Which applies to you?
I am a Practicing Corneotherapist
I am currently training to become a Corneotherapist
I wish to become a Corneotherapist
What treatments do you currently offer? PLEASE NOTE THAT: Chemical, Algae, SQT, Cool Peels, Alkaline Wash, Micro Dermabrasion, Dermaplaning, Excessive Exfoliation Methods, HydraFacial, Ablative laser, RF Microneedling and any other treatment which remove the precious corneocytes OR do not align with Prologic and the Corneotherapy Principles we adhere to, applications CANNOT be accepted whilst you are offering any of these treatments to clients
*
I do not practice or offer any of the above chemical or ablative treatments
What products do you currently use and retail in clinic?
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Are you a minimum of Level 2 Facials (VCTC, CIBTAC, ITEC, CIDESCO NVQ) qualified
*
Yes
No
Have you completed the IAC Corneotherapy training and Membership? (Required)
*
Yes
No
I intend to complete
Have you completed VTCT Level 2 Infection Prevention
*
Yes
No
Submit
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