Dental Herb Company®Inc.

Boca Raton, FL  33487

Patient Information

Dental Herb Company® does not accept telephone inquires from patients. Please communicate with us via e-mail by completing the following questionnaire. We will then send you patient literature and pricing information.

Dental Herb Company® products are sold through dental offices.

There are two ways for patients to obtain them:

1. Purchase from your dentist

2. Dental Herb Company® PATIENT REFERRAL PROGRAM
Ask your dentist to FAX us a short note on their letterhead, stating your are a patient of record, and giving permission for us to sell products directly to you.

Our FAX number is (561) 241-4480.
As soon as we receive the FAX, we will contact you and take your order.


Required Fields are indicated by an asterisk*.

Name:*

Address:*

City:*

State/Province:*

Zip/Postal Code:*

Daytime Phone(s):*
Email Address:*

 

How did you hear about Dental Herb Company® Products?*    

 

Have you ever used Dental Herb Company® Products?*    
If so, which products have you used?*

 

 

Where did you obtain the Products?*    

 

Are you currently using Dental Herb Company® Products?*    

If so, which products are you using?*    

 

Where are you obtaining the products?*    

 

Are you currently under the care of a dentist?*    

If so, what is your dentist’s name (optional)?

 

What is the dentist’s telephone number (optional)?

Comments:


Back to Home Page of Dental Herb Company®