We are very pleased you are considering our software for your professional practice. To serve you quickly and efficiently, please provide us with the following information.

Contact Information
First name
Last name
Company
Address 1
Address 2
City ST/PROV
ZIP
Country

Email

Phone
Cell Phone
FAX

Office Setup
Currently own a Macintosh? select Yes No
What models?

Plan to order new hardware? select Yes No

Currently use another dental software? select Yes No
What brand?:

Number of workstations currently :
Have plans to add more? select Yes No

Many of our referrals come from our dentists. Please tell us how you heard about us so we can properly thank or acknowledge the proper source. How did you hear about us?
Apple Web Site
Another dentist (provide name)
Publication
Web Search

About the Demo
A standard demo is provided electronically in Macintosh zip format. This software will enable you to fully utilize all basic features of the program. When you purchase ToothPics, every transaction will be safely retained.

If you need other service, please telephone, fax or email contact us with your specific requirements.

To Order a demo by phone call 800.218.0531