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Cutera Rep Patient Accelerator Program Intake
Cutera Sales Rep Name
*
Practice Legal Name
*
Legal name of the practice you’ve sold a Cutera device to.
Practice Forward-Facing Name
*
How the practice wants to be known by their clients for this campaign.
Device(s)/Program(s) Covered by the Patient Accelerator Program
Hidden
Please select all applicable devices/programs covered for this client
*
Enlighten – PicoGenesis/Skin Rejuvenation
Enlighten – Tattoo Removal
Excel HR
Excel V+ Laser Genesis
Excel V+ Vascular
Fraxis PRO/Secret Pro
Juliet
Secret RF Microneedling
truBody (Practice has iD & fleX)
truSculpt iD
truSculpt fleX
Xeo Laser Genesis
Xeo Laser Hair Removal
Select first device/program covered for this client
*
Enlighten – PicoGenesis/Skin Rejuvenation
Enlighten – Tattoo Removal
Excel HR
Excel V+ – Laser Genesis
Excel V+ – Vascular
Fraxis PRO / Secret PRO
Juliet
Secret RF Microneedling
truBody (client has iD & fleX)
truSculpt iD
truSculpt fleX
XEO – Laser Genesis
XEO – Laser Hair Removal
This device should be part of the Patient Accelerator Program
Is the Turbo Marketing a Lease Program, or a Full Purchase Program?
*
Lease
Purchase
What is the term of this program?
*
3 Months
6 Months
12 Months
How long will Cutera be paying for this client to market this program? Applicable for leased and purchased devices.
What is this device's Sales Order Number?
*
Has the client paid Cutera in full, or is there a remaining balance?
*
Paid
Remaining Balance
If "remaining balance," how much?
Please enter a number greater than or equal to
0
.
Is this client covered for a second device/program?
*
Yes
No
Select second device/program covered for this client
*
Enlighten – PicoGenesis/Skin Rejuvenation
Enlighten – Tattoo Removal
Excel HR
Excel V+ – Laser Genesis
Excel V+ – Vascular
Fraxis PRO / Secret PRO
Juliet
Secret RF Microneedling
truBody (client has iD & fleX)
truSculpt iD
truSculpt fleX
XEO – Laser Genesis
XEO – Laser Hair Removal
This device should be part of the Patient Accelerator Program. Do not select a device you have already entered in this form.
Is the Turbo Marketing a Lease Program, or a Full Purchase Program?
*
Lease
Purchase
What is the term of this program?
*
3 Months
6 Months
12 Months
How long will Cutera be paying for this client to market this program? Applicable for leased and purchased devices.
What is this device's SO number?
*
Has the client paid Cutera in full for this second device, or is there a remaining balance?
*
Paid
Remaining Balance
If "remaining balance," how much?
Please enter a number greater than or equal to
0
.
Is this client covered for a third device/program?
*
Yes
No
Select third device/program covered for this client
*
Enlighten – PicoGenesis/Skin Rejuvenation
Enlighten – Tattoo Removal
Excel HR
Excel V+ – Laser Genesis
Excel V+ – Vascular
Fraxis PRO / Secret PRO
Juliet
Secret RF Microneedling
truBody (client has iD & fleX)
truSculpt iD
truSculpt fleX
XEO – Laser Genesis
XEO – Laser Hair Removal
This device should be part of the Patient Accelerator Program. Do not select a device you have already entered in this form.
Is the Turbo Marketing a Lease Program, or a Full Purchase Program?
*
Lease
Purchase
What is the term of this program?
*
3 Months
6 Months
12 Months
How long will Cutera be paying for this client to market this program? Applicable for leased and purchased devices.
What is this device's SO number?
*
Has the client paid Cutera in full for this third device, or is there a remaining balance?
*
Paid
Remaining Balance
If "remaining balance," how much?
Please enter a number greater than or equal to
0
.
Does the Practice have additional Cutera Devices not covered by the Patient Accelerator Program?
Yes
No
What other Cutera Devices do they have?
Enlighten
Excel HR
Excel V+
Fraxis PRO/Secret Pro
Juliet
Secret RF Microneedling
truSculpt iD
truSculpt fleX
Xeo
Who is Turbo's Point of Contact for this practice?
*
Point of Contact's Phone
*
Point of Contact's Email
*
