Dental Wizard Order Form

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WELCOME • FREE 7-DAY TRIAL • TESTIMONIALS • PURCHASE

2 WAYS TO EDUCATE YOUR PATIENTS!

1
Dental Wizard DVD-R
for DVD-R player or computer DVD-R drive
Choose individual tutorials or
loop all for reception area viewing

Dental Wizard DVD-R: $995
for the first DVD-R purchased by a practice, per location.
Additional DVD-Rs for the same practice location
are $99 each (see below)

TO ORDER, FILL IN THE FOLLOWING AND CLICK ON THE SUBMIT BUTTON BELOW:

CHOOSE LANGUAGE:

Practice Name

Practice City, State & Zip

Practice Phone No.

Practice Web Site Address

Practice Email Address

Contact Person at Practice

DVD-R MENU CUSTOMIZATION (required)

• Doctor(s) and/or Practice Name
• Tagline (e.g. "We brighten your smile!")
• Practice Phone No.
• Additional Info (address, web site, etc.)

Line 1:
Line 2:
Line 3:
Line 4:
Line 5:

____________

Additional DVD-Rs: $99 each
(available for purchase for the same practice location after purchase of the 1st DVD-R or the server version for that location)

TO ORDER, FILL IN THE FOLLOWING AND CLICK ON THE SUBMIT BUTTON BELOW:

CHOOSE LANGUAGE:

Practice Name

Practice City, State & Zip

Practice Phone No.

Practice Web Site Address

Practice Email Address

Contact Person at Practice

DVD-R MENU CUSTOMIZATION (required)

• Doctor(s) and/or Practice Name
• Tagline (e.g. "We brighten your smile!")
• Practice Phone No.
• Additional Info (address, web site, etc.)

Line 1:
Line 2:
Line 3:
Line 4:
Line 5:

2
Dental Wizard Web-link
on practice Web Site or free Web portal

Dental Wizard Web-Link Subscription:
$50 per month*

INITIAL COST: $245
• Setup fee = $195
• 1st month of Web-link subscription = $50

Beginning the second month of your DENTAL WIZARD Web-link Subscription, a monthly subscription fee of $50* will be automatically billed to your credit card. No minimum term. You may cancel at any time.

*The Web-link subscription fee of $50 per month is based on one practice location with up to 10 treatment rooms. Contact us for volume pricing if your customer has more than 10 treatment rooms or more than one location.

TO ORDER, FILL IN THE FOLLOWING AND CLICK ON THE SUBMIT BUTTON BELOW:

Practice Name

Practice City, State & Zip

Practice Phone No.

Practice Web Site Address

Practice Email Address

Practice Web Designer's Email Address

Contact Person at Practice

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