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Please complete ALL of the information below and return for
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Name:
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Office Phone: Office Fax:
Year of graduation:
 
I'd like to receive more information about:
Air Compressors
Amalgamators
Amalgam Separators
Cabinets
CAD/CAM
Computerized Anaesthetic         Delivery
Computers
Cone Beam CT (3D Imaging)
Curing Lights
DENTRIX
Endo Equipment
Film Processors

"Green Heart" Program
Intraoral Cameras
Lab Equipment
Lasers
Nitrous Oxide Systems
Office Design Services
Operatory Chairs
Operatory Delivery Systems
Operatory Lights
Oral Cancer Detection
Patient Education Software

Preventative Maintenance         Programs
Sterilizers
Stools
Ultrasonic Cleaners
Ultrasonic Scalers/Polishers
Vacuum Systems
X-ray - Digital        (Phosphor/Sensor)
X-ray - Intraoral
X-ray - Panoramic        (Digital/Analog)
X-ray Viewers
Reason for inquiry:
Immediate purchase Future purchase Information only

How many operatories are in your practice? or

How many of the following are in your practice?
Dentists or
Hygienists or
Assistants or

Specialty (Please check all that apply):
General Dentist
Orthodontist
Oral Surgeon
Periodontist
Endodontist
Prosthodontist
Pediatric Dentist
Oral Pathologist
Public Health
   

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