Free samples

Our free sample packages are for US dental professionals only, not for individuals.

Limit of one product sample per professional license number and practice address.

All sample requests are subject to practice address and license number verification.

Request information

Your Name:

Enter your name, or the person to whom the samples should be sent to at the office

E-mail address:

Enter a valid email address for confirmation

Practice information

Practice Name:

Enter the name of the dental office

Address:

Enter the address of the practice

City:

Enter the city of the practice

State:

Enter the state of the practice

Zip:

Enter the zip code of the practice

Phone number:

Enter the phone number of the practice - may be used for verification purposes

Fax number:

Enter the fax number for the practice

Doctor's information

Doctor's Name:

Enter the name of the practicing doctor at the office

Professional license number:

Enter the doctor's professional license number - subject to verification

State of licensing:

Enter the doctor's licensing state

** Available only in the U.S. to dental professionals. Practicing doctors and dental offices only, no students. We reserve the right to validate your license number, issuing state, and practice address for shipping.

** Limit one sample package per dental professional. Dental Elite will not acknowledge duplicate submissions and has the right to deny requests for samples for any reason.

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Free samples