Philips Healthcare

Philips oral healthcare & your practice

To book a Philips Sonicare or Philips Zoom demonstration, to order a trial unit or for more information, contact us using the form below. To speak to a Philips customer service representative directly, call toll free: (800) 203-3344.

Please set your preferences on how we may contact you: To book a Sonicare demonstration Lunch & Learn To receive Professional Trial unit price information To be contacted by a Sonicare sales representative To receive more information about Sonicare Power Toothbrushes To receive more information about Sonicare AirFloss To receive educational materials To order Sonicare display material for my practice

									Dental Practice *
									
										Mr.
									
										Mrs.
									
										Ms.
									
										Dr.
									
									First name *
									
									Last name *
									
									E-mail *
									
									Phone Number *
									
									Address 1 *
									
									Address 2
									
									City *
									
									State *
									
									Country *
									
									ZIP Code *

										Do you currently recommend Sonicare?
										
										Yes
										
										No
									
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										Yes
										
										No
									
											I accept Terms of use and Privacy policy

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Address Information

Please complete your address information.

Address 1 *

Address 2

									City *
									
									State *
									
									ZIP Code *

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Follow up Information

Please specify the follow up and answers you wish to receive.

Follow up *

Estimated time of purchase *

Comments

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Training Information

Please select your preferred and alternate dates and locations. If you have any dietary preferences please let us know.

Training Date *

Alternate Date

Training Location *

									Alternate Location
									
									Data Selection
									
									System Serial Number

Comments

Dietary Needs

Thank You

We will follow up with your request as soon as possible.
We appreciate you taking the time to contact us.

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