Please fill out the form below using your personal information. You will use the email and password
entered to log into Aesthete Genius once accepted. We will use this information to validate who you are.
Provide the name and address of your practice. We will use this information to validate and verify your
identity and practice standing.
Add clinic +
Review your information
If you're satisfied with the changes made you may submit the form, otherwise feel free to make any edits.
Thank you for signing up
We'll take a few business days to review your information. If we require more information we will reach
out to you using the contact information you provided. If you have any questions you can contact us at
You may now check your account status by using the email address and password you supplied earlier and
logging into the system.