Pentron Bond 1



Name/Degree (*)   Telephone (*)
Practice Location   Fax
Address1 (*)   Email (*)
Address2   Do you currently lecture?
City/State/Zip (*)   How many times/year?
      Hygiene School
      Year Graduated

Please tell us if you are affiliated with any dental manufacturers.



  Brief Career Highlights

Thank you for agreeing to serve on the panel of product evaluators for Dental Product Shopper and Integrated Media Solutions. At the end of the 4-week in-office evaluation, you will complete an evaluation form at our password-protected website. If you are reviewing a consumable product, you will be able to keep it. Nonconsumables and larger products (such as radiography equipment, lasers, intraoral cameras, etc) should be returned to the manufacturer. The shipping costs will be covered by the manufacturer. In addition, we ask our evaluators to occasionally answer questions from their dental professional colleagues regarding the evaluated products. These questions and answers are posted anonymously on the DPS web site. At the time you are invited to participate in an evaluation, a DPS editor will ask if you are willing to answer questions from your colleagues. In addition, we will feature photos and short bios of our evaluators on the Dental Product Shopper web site home page on a rotating basis.



To ensure that you are asked to evaluate products appropriate to your practice and patient demographic, please check the categories below that represent your primary areas of interest. You must choose a minimum of one area of interest.

 Toothbrushes  Probes  Loupes
 Floss  Infection control  Topical Flouride
 Prophy paste  Patient education software  Whitening
 Prophy angles  Sealants  Analgesics
 Toothpaste  Periodontal antibiotics  Anesthetics
 Hand instruments  Instruments  Instrument sharpeners
 Rinses  Oral cancer detection  Materials
 Gum  Caries detection technology  Prosthodontic maintenance
 Scaler  Ultrasonics  Radiography
 Desensitizers  Ultrasonic Tips  Gloves
 Other (please specify)