Colgate Sign-Up- NDHM 2024

Sign up for a complimentary professional product sample from Colgate! As part of National Dental Hygiene Month, you can register to explore this new offering which may include product samples. These samples will be available in early 2025. This opportunity is provided for educational and familiarization purposes only. By participating, you acknowledge that this does not constitute an endorsement or obligation to recommend the product.

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Personal Details **

Email*

Mobile Number*

Office/Practice Shipping Address **

Samples must be shipped to a place of business.

Do you currently dispense/prescribe PreviDent® 5000 or another brand of high concentration prescription fluoride toothpaste for your patients at high or moderate caries risk? **

I currently dispense/prescribe PreviDent 5000.

I currently dispense/prescribe another brand.

I do not dispense/prescribe high concentration prescription fluoride toothpaste at this time.

Which brand do you recommend?*

Please let us know which brand you dispense/prescribe.

Why do you use your selected brand?*

Please briefly describe why you use the brand you selected.

Do you primarily dispense high concentration prescription fluoride toothpaste in the office or do you write prescriptions? **

Do you primarily dispense high concentration prescription fluoride toothpaste in the office or do you write prescriptions? *

I dispense in the office.

I write prescriptions.

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