Skip to content
For Providers
Dispense in Office (DIO)
Direct to Patient (DTP)
Topical Anesthetics
Medications Directory
Providers FAQ
New: Kefunova Cream
For Patients
Your Journey
Patient FAQ
About Us
Why 503B
Blog
Podcast
News
Login
Provider Login
Patient Login
Order Anesthetics
Menu
For Providers
Dispense in Office (DIO)
Direct to Patient (DTP)
Topical Anesthetics
Medications Directory
Providers FAQ
New: Kefunova Cream
For Patients
Your Journey
Patient FAQ
About Us
Why 503B
Blog
Podcast
News
Login
Provider Login
Patient Login
Order Anesthetics
For Providers
Dispense in Office (DIO)
Direct to Patient (DTP)
Topical Anesthetics
Medications Directory
Providers FAQ
For Patients
Your Journey
Patient FAQ
About Us
Why 503B
Blog
Podcast
News
Login
Provider Login
Patient Login
Order Anesthetics
Contact Us
Menu
For Providers
Dispense in Office (DIO)
Direct to Patient (DTP)
Topical Anesthetics
Medications Directory
Providers FAQ
For Patients
Your Journey
Patient FAQ
About Us
Why 503B
Blog
Podcast
News
Login
Provider Login
Patient Login
Order Anesthetics
Contact Us
Contact Us
Search
Search
Co-Branded Marketing Materials Form
Co-branding MKTG Materials Form
Consultant Name
*
Consultant Name
First
First
Last
Last
Email
*
Your Manager's Email
*
Practice Name
*
Location
*
Attention to (if applicable)
Shipping Address
*
Shipping Address
Shipping Address
Shipping Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Shipping Address
Co-Branded Banners
Generic Retractable Banner (33x81)
0
1
2
4
Acne Retractable Banner (33x81)
0
1
2
4
Co-Branded Table Tents
Table Tents - Double-sided (5x7)
0
10
25
Co-Branded Wall Clings
Please note the quantities you need for each wall cling. We recommend 1-2 per exam room.
Acne
Alopecia
Anti-Aging
Eczema
Melasma
Psoriasis
Rosacea
Sensitive Skin
Dermatitis
Anti-fungal
Warts
5-FU
Generic
DIO
DTP
Practice Logo Upload
*
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
High-resolution logo. Preferred formats are SVG, AI, EPS or large PNG.
Upload the Inventory Sheet
*
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Please add any comments here.
Submit
If you are human, leave this field blank.