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Fields marked with an asterisk (*) are required and must be completed in order to submit the form successfully
Regional Hygiene Manager*
What is the name of your office?*
What is the address?*
What is the PMS?*
How many operatories will be installed?*
How many Hygienists will be trained?*
How many microphones will be needed? (1 per station/1 per user?)*
More than one RDH? Fill out below
Please provide a point of contact for the Office
I confirm this request was approved by my RCSM*
* Please make sure to have your Windows login and password, PMS login and password available on the installation day. We will need this information to proceed with the installation process smoothly.
Please choose a date to schedule installation!
2. Schedule the Installation
Please choose a date to schedule training!
(feel free to book multiple training sessions as needed)
3. Schedule the Training
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