MEDSPA APPLY – Lavion

Contact Information

Full Name *

Please enter your full name.

Business Name *

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Email *

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Phone Number *

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Website or Instagram

Business Profile

Business Type *

Med Spa Wellness Clinic Functional Medicine Aesthetic Practice Other

Please select a business type.

Address

City

State

Zip Code

Clients per month *

<50 50–150 150–300 300+

Please select a range.

Current Services

What services do you currently offer? *

Select all that apply.

IV Therapy Injectables (Botox, fillers) Peptide Therapy Hormone Therapy Weight Loss Other

Please select at least one service.

Medical Oversight

Provider Name *

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Credential Type *

Please select a credential type.

NPI Number *

NPI must be exactly 10 digits.

State License Number *

Please enter the license number.

Licensing State *

Please select a state.

Intent

How are you planning to integrate peptide therapy? *

In-clinic only Retail / take-home Both Not sure yet

Please select an option.

What is your primary goal with adding LavION? *

Increase revenue Expand service offerings Improve patient compliance Replace or complement existing peptide protocols Other

Please select an option.

Application Submitted!

Thank you for your interest in becoming a LavION partner. Our team will review your application and follow up within 24–48 hours.

Apply to Become a LavION Partner