Request Educational Support Material

Educational Support Material request form
Dental Professionals practicing in the US are eligible for Free Samples through this request form. If you are practicing outside of the U.S., you can find your region's TePe resource here.
First Name*
Last Name*
E-mail*
Phone Number

Area CodePhone Number
Dental Office / Company Name*
Type of Educational Support Request*

Patient Order FormsIllustrator (Dental Floss vs. Interdental Brush)Caring for your children's teeth leafletCaring for your healthy smile leafletCaring for your mouth throughout life leafletCaring for your gums leafletCaring for your braces leafletCaring for your implants leaflet
Type of Dentistry*
Shipping Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Country
Message
Should be Empty:

Educational Support Material request form