Philips Healthcare

Philips oral healthcare & your practice

To book a Philips Sonicare or Philips Zoom demonstration, order a trial unit or for more information, please contact us by filling in the form below. Emails will be responded within 24-48 business hours. To speak to a Philips customer service representative directly, call toll free: 1800 621 448.

Please set your preferences on how we may contact you: To order Zoom whitening kits To receive a Philips Zoom demonstration at my practice 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

									Dental Practice *
									
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										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?
										
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Address Information

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Address 1 *

Address 2

									City *
									
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									ZIP Code *

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Follow up Information

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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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