Registration

REVOLAX PRODUCTS ARE ONLY SOLD TO QUALIFIED PROFESSIONALS.

If you have not registered with us, please fill in the registration form and we will try to approve your account shortly.

FIRST ORDER NOTICE : We will require a copy of your aesthetic training certificate/medical pin prior to your order being dispatched from our office.

User Name*
E-Mail*
Enter E-Mail Confirm E-Mail
Company
Dermal Filler Certificate*
Accepted file types: jpeg, jpg, gif, png, pdf, Max. file size: 100 MB.
Accepted file types: jpeg, jpg, gif, png, pdf
Aesthetic Insurance Document*
Accepted file types: jpeg, jpg, gif, png, pdf, Max. file size: 100 MB.
Accepted file types: jpeg, jpg, gif, png, pdf
Date of expiration (Aesthetic Insurance Document)*
- Set expiry Date
Insurance Expiration date*
Instagram User name
Name*
First Last
Mobile Number*
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Consent*
I agree to the privacy policy.
Move Do you want to receive exclusive offers, competitions, and industry news from Fox Group?*
- First Yes, I'm happy to receive marketing from Fox Group
CAPTCHA