Access Request

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TUNG

Ready to order TUNG products and need access?

Complete this form, once verified as a dental professional you will receive an account invite by email.

Enter your email address

To ensure exclusivity to the dental industry we request a work email when possible and ship to a dental practice or other business address associated within the dental industry (sorry no home addresses).

Dental Practice Name

Position

What's your role in the practice

License #

Street Address

Must be a business address of a dental practice

City

State

5 Digit Zip Code

Phone #

Tell Us About Your Practice

Type of Practice

General Dentistry

Pediatric

Periodontist

Endodontist

Orthodontist

Oral Surgeon

Other

How many cleanings does your office do each week?

Average number of patients per week, per hygienist

Additional Information you would like to share

Unfortunately we are required to ask by law (insert eye roll). By checking this box you agree to receive follow up communications and accept the data privacy statement.

Don't worry we will rarely bother you as we dislike emails too and more importantly have an allergy to extra work.

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