Resources Request Form

I would like to order the following for my
agency / organization:

Enter Quantities Desired. Subject to Availability. While we will make our best effort to fulfill your request, we cannot guarantee fulfillment.

Dental Kits can be ordered in quantities of 1-10, or a bag of 25, or a box of 50. No more than 1 box per dental kit type per month.

Contact your Dental Health Care Specialist if you have any questions)

GOT HUSKY HEALTH? CALL 855-CT-DENTAL - ENGLISH

GOT HUSKY HEALTH? CALL 855-CT-DENTAL - SPANISH

BRUSHING AND FLOSSING TIPS (ENGLISH-SIDE 1 / SPANISH - SIDE 2)

WE CARE ABOUT YOUR DENTAL HEALTH - GENERAL BROCHURE WITH LISTING OF BENEFITS

YOU AND YOUR INFANT

YOU AND YOUR BABY

BENEFITS OF FLUORIDE VARNISH (INFOGRAPHIC)

A HEALTHY BODY STARTS WITH A HEALTHY MOUTH

BRACES AND ORTHODONTIC TREATMENT - ENGLISH

BRACES AND ORTHODONTIC TREATMENT - SPANISH

CARING FOR YOUR DENTURES - ENGLISH

CARING FOR YOUR DENTURES - SPANISH

DENTAL REFERRAL PADS

MEDICATION DENTAL WATCH LIST

ADULT DENTAL KITS (8 - 65+)

ADULT DENTAL KITS (ADOLESCENT - 65+)

CHILD DENTAL KITS (AGE 4 - 7)

CHILD DENTAL KITS (AGE 4 - ADOLESCENT)

PRE-NATAL DENTAL KITS (MOMS TO BE)

INFANT DENTAL KITS (AGE 0 - 3)

FAMILY DENTAL KITS - FOR FAMILIES WITH CHILDREN AGE 3+

Your Organization’s Name

Your Name

Your Email

Mailing Address

Your Phone

Do you need these for a specific event / date?

If Yes, date needed by

Thank you for helping your clients maintain good oral health.
Your Dental Healthcare Specialist will contact you regarding your order.