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First Name:
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Practice:
SELECT
General
Ortho
Endo
Perio
Pedo
Other
# of Operatories:
#of Hygienists :
# of Prophy Cleanings Per Week:
Samples:
New
Classic Elite LF
D-Lish EZ-Pak (Short Cup)
New
Contra Elite LF
Prophy Cups
Classic Disposable Prophy Angles
Prophy Brushes
Contra Disposable Prophy Angles
D-Lish Prophy Paste
Latex-Free Disposable Prophy Angles
Moisture Control (Surg-O-Vac, Vent-O-Vac, Dri-Aid)
Petite Disposable Prophy Angles
Disclosing Agents
Junior Disposable Prophy Angles
HO Bands
D-Lish EZ-Pak (Long Cup)
