Lumenis | Find a Practitioner | Physician Referral Form

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Enter your E-mail address or Username, and Password

Practitioner Referral Service Registration Form

If your practice is located outside of the USA,
please click here.

Practitioner's Name:

Practice Name:

Specialty:

Product Serial#:

Address1:

Address2:

City:

State:

Zip Code:

Phone Number:
Area Code First

Fax Number:
Area Code First

E-mail Address:

Website Address:

I don't have a web site but would be interested in establishing one.

Lumenis™ Systems available in your practice (check all that apply):

AcuPulse

Aluma

IPL Quantum

LightSheer

LightSheer Duet

Lumenis One

M22

UltraPulse Encore (ActiveFX & DeepFX)

Other Lumenis Product:

Services (check all that apply):

Acne (IPL)

Birthmarks (IPL)

Fine lines, Wrinkles & Sun Damage (ActiveFX, DeepFX & AcuScan120)

Photorejuvenation (IPL)

Red & Brown Spots, Freckles & Sun Damage (IPL)

Rosacea (IPL)

Scars: Acne, Burns, Keloid & Trauma (ActiveFX & DeepFX)

Hair Removal (LightSheer & LightSheer Duet)

Veins (IPL)

		Please contact me as I have interesting cases and/or before and after photographs which I am interested to share and/or release for publication



		Comments:

Please enter a password. (Min. 5 characters)
In combination with your e-mail address above, you can use this password to edit your information in the future. You may also choose a username to log in with. If your practice has multiple accounts with the same email address, you will need to use a username to log in.

Username:

Password:

May take 2-3 weeks for listing to get approved and show up in search listings.