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Please take 5 - 10 minutes to answer a few questions for us to get to know you better and understand your needs and goals.

Please note, this form is for domestic prospects. If you are interested in becoming an International Distributor please click here.

Practice Information 1. What is the name of your practice? 2. We are proud to work alongside leading skin health professionals. Please provide your practice type designation3. Please provide your practice website URL 4. Please provide your Clinic/Practice Instagram handle 5. Practice Street Address 6. Practice City 7. Practice State 8. Practice Zip Code

Contact Information 9. Your first name 10. Your last name 11. What is your primary role in the practice?12. Best phone number to reach you 13. What is your email address? 14. Please provide your professional Instagram handle (if applicable)

Practice Details 15. How many employees does your clinic/practice staff?16. On average, how many patients/clients is your practice collectively seeing a day? 17. How many years has your clinic been in business? 18. Corporate Affiliation Group:

Corporate Affiliation Group - Other:

19. What skin care lines do you currently offer in your practice (Check all that apply)

Alastin CO2 Lift DMK EltaMD Epicutis GlyMed Hydrenity ISDIN Jan Marini NeoCutis Obagi Other Plated Private Label Revision Sente SkinBetter Science SkinCeuticals SkinMedica ZO

20. What is your annual revenue generated by skincare alone in your practice?21. What system do you currently use to manage patient records and track skincare purchases?

22. What procedures and services does your clinic currently offer? Check all that apply

Chemical Peels Cosmetic Surgical Procedures Facials Fillers Hydrafacial/ Diamond Glow / Microdermabrasion IPL / BBL Laser Neurotoxin Non-Surgical Body Contour (cool sculpt, EMSculpt)

Decision & Fit Questions 23. How did you hear about Colorescience?24. If someone referred or recommended Colorescience to you, please share who so we may thank them 25. Why are you most interested in bringing Colorescience into your practice now?26. What is the timing on when you would like to bring in the line?27. Science is in our name, and we are known for our investment in clinical research. Have you had the chance to review any of our peer reviewed and published clinical studies?28. What is going to be the biggest factor in choosing to bring Colorescience into your practice? (Choose the most important)29. Colorescience partners receive annual membership to our Professional Academy. An on-demand university where your team can take modules, assessments and earn certificates. For investing in their knowledge, we reward your team with free product. Would this be of value to you?30. Colorescience has a loyalty program called Lasting Beauty Rewards that rewards both your staff and your patients for purchasing Colorescience from you. It also rewards patients for having their annual skin check and having Colorescience applied post their procedure with you. Would this be a program of value to you and your patients?31. Colorescience offers our partners customized microsites to be able to easily offer Colorescience repurchases for your patients via your website. Would this be of interest to you?32. At Colorescience we operate in a unique structure to provide partners the specific expertise they need based on where they are in their lifecycle with Colorescience. We meet our partners where they are. As a New Partner you will work directly with a New Business Development Manager. Our team does not just pop by your clinic, our team of experts will schedule SUCCESS planning meetings and trainings virtually so we can be flexible to your schedule.33. Colorescience does have minimum order requirements including ordering in quantities of 6 per sku, opening order perks benefits with order of $3,000+, and reorder minimums at $500.34. Colorescience requires all Authorized Resale partners to have the business owner directly involved in three aspects of the partnership: signing new account opening partner agreement, committing to being part of the opening order finalization and committing to quarterly success meetings. Is the business owner for your practice able to commit to these authorized reseller requirements?35. After getting to answer the intake questions would you like to continue to proceed to the next step and receive access to Clinical Studies and a brand overview introduction?

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