Clinical Partner Application

👤 Personal Information

Basic details so we can contact you.

Full Name *

Email Address *

Mobile Number / WhatsApp *

Clinic Name *

Clinic Address *

City *

🎓 Professional Information

Tell us about your medical background and credentials.

Highest Qualification *

MBBS FCPS Dermatology MCPS Dermatology Diploma in Dermatology Other

Years of Clinical Experience *

Do you currently own or co-own your clinic? *

Yes No

Do you practice at multiple clinics? *

Yes No

🌐 Social Media Presence

Your social channels help us understand your personal brand potential.

Instagram Profile URL

Facebook Page URL

TikTok Link (if any)

YouTube Channel Link (if any)

Approximately how many patients do you see per month? *

🎬 Content Collaboration

We love co-creating high-quality educational material with our clinical partners.

Would you be comfortable creating educational content with our team? *

Yes No

Would you allow our content team to visit your clinic for professional shoots? *

Yes No

Would you be comfortable documenting real patient journeys (with proper patient consent)? *

Yes No

What type of content would you enjoy creating? *

Educational videos Patient consultations Before & After case studies Podcasts Live Q&A sessions All of the above

🏥 Clinic Partnership

Bringing evidence-based options directly to clinic desks.

Would you be interested in keeping our scalp and hair care products available at your clinic? *

Yes No

Are you open to recommending our scalp and hair care products when clinically appropriate? *

Yes No

Would you be interested in participating in future product testing and feedback? *

Yes No

🤝 Long-Term Partnership

Let's align on mutual growth opportunities.

Which opportunities interest you? *

Affiliate Partner Paid Content Creator Clinical Advisor Long-Term Brand Ambassador All of the above

Why would you like to partner with us? *

📁 Uploads

Please share your documents. Large files up to 10MB are supported.

Your Latest CV / Profile (Optional)

📄

Click to upload PDF, DOC, DOCX or PNG — Max 10MB

PMDC Registration Certificate *

📜

Click to upload PDF, JPG, JPEG or PNG — Max 10MB

Clinic Photographs (Optional)

📸

Click to upload JPG, JPEG or PNG — Max 10MB

I confirm that the information provided above is accurate, and I understand that submitting this application does not guarantee selection. If shortlisted, our team will contact me for the next stage of the partnership process. *