Thank you for your interest in the Omni product line, we are excited to work with you! Please fill out the form below, and within 2 business days you’ll receive an email confirmation of approval, or an Omni agent will reach out if further information is needed.

*Please make sure to check your spam folder.

• Username*
• First Name*
• Last Name*
• E-mail*
• Company Information* Please tell us a little about your company or practice and what kind of procedures and/or lasers you use and/or perform.
• Practicing License #
• Practicing License
  Please enter or upload your current medical/aesthetic license.
• Resale Cerificate #
• Resale Cerificate
  Please enter or upload your resale certificate number to be tax exempt.
• How did you hear about us?*
• Password*

• Send these credentials via email.