Cosmetic Finance Group

Please fill in the information below to apply to become part of the CFG family.

General Details

Your Full Name*

This is a required field

Phone Number*

This is a required field

Secondary Phone Number

Clinic Details

Clinic / Business Name*

This is a required field

Clinic Contact Email Address*

Please enter a valid email address

Clinic Website

Clinic Address 1*

This is a required field

Clinic Address 2

Town/City*

This is a required field

Postcode*

This is a required field

Companies House Number

Profession*

This is a required field

Pin number(NMC/GMC/GDC)

Prescriber Name

Prescriber Email

Prescriber Pin

Account Login Details

Your Email Address*

Please enter a valid email address

Password*

This is a required field

Password Confirmation*

This is a required field

Signup Options

BASIC - £150 Sign Up – £50pm i
STANDARD - £299 Sign Up - £50pm i
ELITE – £699 Sign Up - £50pm i

This is a required field

Please Read Carefully

Please ensure that you carefully double check ALL details supplied to us prior to submitting your form.

Errors & incorrect information may result in initial system set up failure - This will cause problems/delays with you receiving customer payments.

Please note we aim to have all clinics live within an estimated time frame of 30 days from the date we have received ALL information required.

We look forward to working along site you, thank you for choosing us.

CFG

I've read and agree to these terms

This is a required field

CLINIC SIGN UP

Please fill in the information below to apply to become part of the CFG family.

General Details

Clinic Details

Presciber Details (if required)

Account Login Details

Signup Options

Please Read Carefully