21 Day Free Laser Trial

Sign Up For The Free Trial

*Clinic Name:

*Contact Name/Title:

*Alternate Contact/Title:

*Shipping Address:

*Clinic Phone:

Email Address:

Cell Number:

*What type of practice do you own?

*Would you like to try the Class 3b or Class 4?

*Do you have any previous laser experience?

*Have you seen any laser demos?

After submitting this form, we will contact you to confirm shipping information for your trial laser. Thank you for allowing us the opportunity to help you explore laser therapy for your practice.