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The Next Generation Of Aesthetic Innovation
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Revance RHA Campaign
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Revance RHA Campaign
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Practice Personalizations
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Practice Information
Your Name
*
First
Last
Hidden
Practice ID
Practice Name
*
Your Email
*
Please enter your email so we can communicate directly with you; you can enter the practices front desk email in the next steps.
Your Rep's Email
*
Please enter your the email of your Revance rep.
Choose Your Color Scheme
Select Color Scheme
*
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Primary Color
Custom Primary Color
If you would like to select a custom color enter the HEX code of your primary color here.
Accent Color
Custom Accent Color
If you would like to select a custom color enter the HEX code of your accent color here.
Upload Your Assets
Please make sure the file is saved either as a png, jpg, pdf or eps.
Practice Logo
*
Accepted file types: png, eps, jpg, jpeg, pdf, svg, zip, Max. file size: 100 MB.
Practice Information
The below information will be printed on the actual touch card.
Doctor Name
*
First
Last
Suffix
Practice Address
Street Address
Address Line 2
City
State / Province
Alabama
Alaska
Arizona
Arkansas
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Patient Quick Access Links
Practice Phone
*
Practice Email
*
Practice Website
*
Submission Approval
Please make sure all of the information above is correct and ready for submission.
Approval
*
Before selecting SUBMIT please check here to verify that all your information is entered correctly.
Consent
I agree to the privacy policy.
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