"*" indicates required fields Step 1 of 2 50% Untitled Practice ID Practice Name Circle Club Tier: Blue Diamond Gold Platinum National Account 1 National Account 2 National Account 3 National Account 4 Remaining Co-Op Balance:NumberPractice InformationAE Email Opp WP ID* City* State*Select StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAccount Executive* HiddenAddress* HiddenPostal / Zip Code* Practice Contact Name* Practice Phone*Practice Contact Email* Choose a FormButtons SUBMIT PROJECT APPROVAL SUBMIT PROJECT REIMBURSEMENT Co-Op Approval FormProject Name*Example Project Name: ZO Skin Centre_Email Blast_Jan 2023. Duplicates are not allowed. Advertisement Type:* Print Digital Co-Branded Items (Event Support, Apparel, etc.) ZO® Print Zone Other Other Advertisement Upload* Drop files here or Select files Accepted file types: jpg, png, pdf, mp4, Max. file size: 80 MB, Max. files: 4. Co-Op Reimbursement FormProject Name* ZO Skin Centre_Email Blast_Jan 2023 ZO Skin Centre_Email Blast_Jan 2024 ZO Skin Centre_Email Blast_Dec2023 test Project Name (Hidden) Total Invoice Cost:*Invoice Upload* Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 10 MB, Max. files: 3. HiddenRemaining Benefitsbenefits remainingHiddenChoose Benefits* Drive traffic to your practice social media page with an exclusive story + highlight feature on the ZO® brand Instagram. Focus on practice growth objectives in a 1-hour marketing consultation with an industry expert. Feature your practice social media pages, website and additional information to help reach more potential patients. Take CO-OP Advertising a step further. Opportunities now include PrintZone, ZO® branded fixtures and event support. Blue Diamond members can be featured on a product page on ZO’s brand website. Blue Diamond members can share an exclusive video in addition to their feature on the ZO® brand Instagram. HiddenPlease provide additional information for your chosen benefits:HiddenZO® Brand Social Media FeatureHiddenBusiness/Office Instagram Handle @* HiddenAbout Us Statement (300 Characters of Less)*Hidden(2-3) In-Office/Team Images* Drop files here or Select files Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 3. Hidden(1) Business Logo* Drop files here or Select files Accepted file types: png, Max. file size: 10 MB, Max. files: 1. Hidden(2-3) In-Office/Team Images true Hidden(1) Business Logo true Hidden1:1 Marketing ConsultationsCLICK HERE to schedule your 1:1 Marketing ConsultationHiddenPremium Listing on Physician LocatorHiddenPractice Website* HiddenCustom POS Link* HiddenInstagram HiddenFacebook HiddenAbout Us Statement (300 Characters or Less)*HiddenCO-OP Flex OpportunitiesCLICK HERE for the CO-OP approval/reimbursement formsHiddenZOSH.com Product Page feature*ZOSH.com Product Page feature is available for a limited time and subject to availability.HiddenSelect your feature type:* Physician/Provider Spotlight (Product recommendation from a specific provider at your practice) Practice Spotlight (Product recommendation from your practice as a whole) Hidden(1) Physician/Provider Headshot* Drop files here or Select files Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 1. Hidden(1) Practice/In-Office Image* Drop files here or Select files Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 1. HiddenPhysician/Provider Name* HiddenPractice Name* Hidden(1) Physician/Provider Headshot true Hidden(1) Practice/In-Office Image true HiddenSelect one ZO® Product for your feature:* Illuminating AOX Serum Rozatrol® Complexion Clearing Masque HiddenWhy do you love recommending this ZO® product to your patients?*HiddenWho is your ideal patient for this ZO® product?*HiddenWhat other ZO® products do you recommend your patients pair with this one?*HiddenZO® Brand Social Media Feature with VideoVIDEO REQUIREMENTS: Create a Meet the Expert video, up to 30 seconds in length, with a Provider focus: self-introduction, with role, office and location, etc. Consider however you would like to be featured - is it highlighting your expertise or experience? Or what inspired/inspires you to do what you do for your patients?HiddenFeatured Provider Name* HiddenBusiness/office Instagram Handle @* HiddenProvider Headshot* Drop files here or Select files Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 1. HiddenUpload Video File* Drop files here or Select files Accepted file types: mp4, mov, Max. file size: 40 MB, Max. files: 1. HiddenProvider Headshot True HiddenUpload Video File True Questions? Please email circleclub@zoskinhealth.comNameThis field is for validation purposes and should be left unchanged.
