Add My Clinic

Are you a qualified healthcare practitioner already using BELOTERO^® Revive and want to be added to our website?

Fill out the form below and we will review your application to be added to our clinic locator.

Terms and Conditions
*Only registered UK and Irish healthcare practitioners, who have purchased BELOTERO^® Revive from Merz Aesthetics approved wholesalers can be added to the clinic locator. Approval of this may take up to 6 weeks to verify.

Your Details

Name *

Enter your name.

Email *

Enter your email address.

Enter Listing Details

Clinic name *

Phone Number *

Website

Professional Registration Number (PIN) *

Wholesaler purchased from

Map Address

( The following fields are used to determine your location on the map. They are NOT displayed anywhere. Enter address to generate the location on the map. Please note, the postcode should have a space in, so put SW1A 1AA rather than SW1A1AA, for example. You can also tweak your location by dragging and dropping the marker in the right place. )

Address *

Region *

Click on above field and type to filter list or add a new region.

City *

Click on above field and type to filter list or add a new city.

Click on "Set Address on Map" and then you can also drag map marker to locate the correct address

Display Address

( The following field is displayed to the user and should be in a human readable format. )

Clinic Address *

Type 64 into this box

Want to find out more about BELOTERO® Revive?

Get in touch with your local aesthetics account manager