How Do You Live Inspired Form

Name *

Email Address *

Phone Number *

Are you an ADHA member? If so, how long have you been a member?

Have you heard of Premier Dental? *

Have you used any of Premier Dental’s products? If so, which have you used?

e.g. Enamel Pro Prophy Paste, Enamelon, PremierAir instruments, BioCoat sealant, Enamel Pro Varnish, 2pro Disposable Prophy Angles, etc.

What brand/type of handpiece are you currently using? *

Do you have experience/are you comfortable being on camera?

Which dates are you attending ADHA 2019? *

Which opportunities are you interested in participating in? *