NDHM 2024 - Colgate SignUp

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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 recommend PreviDent® 5000 or another brand of high concentration prescription fluoride toothpaste for your patients at high or moderate caries risk? **

I currently recommend PreviDent 5000.

I currently recommend another brand.

I do not recommend high concentration prescription fluoride toothpaste at this time.

Which brand do you recommend?*

Please let us know which brand you recommend.

Why do you use your selected brand?*

Please briefly describe why you use the brand you selected.

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

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

I dispense in the office.

I write prescriptions.

Phone

This field is for validation purposes and should be left unchanged.

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NDHM 2024 - Sign Up with Colgate

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