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> My Dermablend > Register
Physician Resource Center Registration
Please register below to access the area this site created for the medical community
Benefits of registering include:
  • Priority response to questions or concerns
  • Free samples of Cover Creme for your practice
  • View and download product information suitable for your patients
  • Personal consultations to dispense Dermablend for your practice
  • MEDICAL PRACTICE/GROUP/DOCTOR NAME:*
    FIRST NAME:*
    LAST NAME:*
    PROFESSIONAL TITLE (DOCTOR, NURSE, PHYSICIAN'S ASSISTANT, ETC)
    STREET ADDRESS:*
    SUITE / APT / FL / OTHER:
    CITY:*
    STATE:
    ZIP:*
    OFFICE PHONE NUMBER:* (FORMAT XXX-XXX-XXXX)
    EMAIL ADDRESS:*
    CONFIRM EMAIL ADDRESS:
    PASSWORD:*
    CONFIRM PASSWORD:*
    Passwords must be at least 6 characters and are case sensitive
    I am interested in dispensing Dermablend, please call or email.