DENTAL
TEAM
SYSTEM™
Online Order Page
*
required fields
NOTE:
If you would like to pay by check,
please call us at
1-866-511-2763
M-F 9am-5pm EST
First, tell us a little about yourself...
*
Name:
(Dentist)
Crown Council Member?
Current/Former Dr. Ron Client?
*
Company Name:
Additional Contact Person:
(other than Dentist)
Size of staff plus Dentist(s):
(total # of people in your practice)
Anything else we should know?
(Your comments here)
Now, please choose your products...
The
"Try Two"
Offer
Not ready to jump in?
For a limited time, get a
Free Executive Review
with Dr. Ron the Dental Coach when you
"Try Two" Now!
Employee Name
Position in Office
$195.00
$195.00
Add Team Members
Take advantage of this temporarily low price to assess your entire team!
$195.00/ea
Enter the name and position of each additional team member
e.g. "Kathy Rasmussen, Chairside"
Employee 1, position Employee 2, position etc
Future Focused
Dentists
$195.00/ea
Number of Dental Team Assessments you would like to Pre-Order
Don't get caught unprepared. Pre-order Assessments to use with applicants the next time you hire.
*
Total Number of Assessments ordered:
*
Total Amount:
Please choose your method of payment...
(all orders are processed on our secure server)
*
Card Type:
Visa
Master Card
American Express
*
Credit Card Number:
*
Expiration Date:
(mmyy, eg. 0103 = Jan 2003)
I prefer to be contacted via:
*
E-mail Address:
E-mail
*
Phone Number :
Fax
Phone
Billing Address:
Fax
Address Line 2:
*Note: if you ordered Assessments for team members, the passwords for those online assessments will be sent to you via e-mail
City:
State/Province:
*
Zip Code:
