Onboarding form for prescription

Access to our prescription and supply services is available exclusively to qualified health professionals. To begin, please complete the onboarding form below by providing your professional details and uploading the required documentation.

This information allows our team to verify your credentials and assess your eligibility to access prescribing support, stock ordering, and practitioner resources. Once your application has been reviewed, you will be contacted via email with the next steps.

Name

First Name

Last Name

AHPRA registration number

Phone

(###)

###

####

Clinic name

Clinic address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

ABN

Years of experience in aesthetic treatments

Proof of credentials

If no prior injectables training has been undertaken, a course and an assessment from Dr. Cindy is required before prescribing. An assessment is required for all injectors when opening an account.

AHPRA registration (screenshot or PDF)

CPR or BLS certificate (current)

Valid photo ID (e.g., driver's license or passport)

Relevant training and certification (include course names, provider and date)

Onboarding form for prescription

Address: Shop 1/17 Macmahon St, Hurstville NSW 2220