Replace My Handpiece

Handpiece Replacement Form

Please use the form below to have your handpiece replaced.

Doctor's Name*
Phone*
Practice Name*
Contact Name*
First Last
Title*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Handpiece Model*
Handpiece Type*
Comments

168 Hobsons Lake Drive, Suite 301, Halifax
Nova Scotia B3S 0G4