Register for a professional account

FOR PROFESSIONALS

REGISTER BELOW IN 2 EASY STEPS!

If you wish to order bulk samples to give your patients or buy our products at professional pricing, please create a username and password below so we may register you for a professional account.

Please note that all accounts must be verified before you can order packs of individually-wrapped samples or professionally-priced cartons.

You’ll get a confirmation email after your account is verified.

Name of Dental Practice (if applicable):
Name*
First Last
I am a*
- Dentist
- Registered Dental Hygienist
- Dental Office Manager
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email address of primary contact:*
Website (if applicable):
Username:*

Please select a username to be associated with your account:
Email*

Please select an email address to be associated with your account: it doesn’t need to match the primary contact email address.
Password*
Enter Password Confirm Password

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REGISTER BELOW IN 2 EASY STEPS!

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