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Samples & Savings

Two ways to share the effectiveness of ACT® oral care products with your patients:

(Choose one or both)

Fill out the form below to receive free ACT coupons for your dental practice. Please allow 4-6 weeks for delivery.
Call 1-855-270-5545 to request 2 free cases of trial size samples for your patients. Mention promo code "ACTpro21" and pay just $19.95 processing and shipping for every two cases ordered. Limit 20 cases per office.

All fields required unless marked optional.

First Name

Last Name

Email Address

Other Title

Practice Name

State License Number (Optional)

Address Line 1

Address Line 2 (Optional)

City

State

ZIP Code (xxxxx or xxxxx-xxxx)

Phone (xxx-xxx-xxxx)

Please Select One The address information provided is a practice/office/business address.The practice address information provided is located at a residential address.The address information provided is a residential address. Note: Fulfillment of any future sample offers cannot be shipped to residential addresses or P.O. Boxes. Practice address is preferred.