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Sample Request
Sample Request

Still unsure if you are ready to make the switch to Crystal Tip? Please fill out the form below and send it in. We will send you a free sample pack of Crystal Tips so you can see for yourself why so many other dental offices have already MADE THE SWITCH! Be sure to let us know which tip you are currently using. If your current tip required a proprietary adapter and you didnít save the original, we will include a new adapter with your samples. Simply fill out the form below, including your current tip, or call us at 800-944-3939.

Your Name:   Doctor's Name:
Office Address:   City:
State:   Country:
Zip Code:   Phone:
Fax:   Email:
Syringe Type:  
Adec-Style DCI Don't Know
If you don't know your syringe type, please go to the Switch section and click on ID Your syringe. Or call us at 800-944-3939.