NicholsMD

Influencer Application

Attendee Email

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth

Instagram Handle:

Number of Instagram Followers:

Do you have an active TikTok?

Do you have an active YouTube (post at least once a month)?

Do you have an active blog (post at least once a month)?

Are you an existing NicholsMD or SkinLab patient?

What do you like to post about?

What are your main follower demographics?

What treatment(s) are you interested in?