Congratulations. You are almost done.  

Now we need to know what we should engrave on your DentaFication® bracelet and/or Dog-Tag.

Please fill in the form below and submit it to permit the commencement of the manufacture of your personalized DentaFication® bracelet or dog tag. 

  1. To measure the wrist, cut a strip lengthwise from an 81/2 X 11 piece of paper.
  2. Wrap it snugly, but not too snug, around the wrist and mark where it overlaps.
  3. Straighten out the strip of paper and measure. That is the wrist size.
  4. We will add approximately 1/4 inch for your comfort on those puffy days.

 

* Your Name
* Your Phone & Email
* Your Email
* Your Street Address
* City, State & Zip
* Patient's Name
* Patient's Address
* City, State & Zip
* Date of Birth
* Contact's Name & Phone
* Dentist's Name & Address
Select Product Bracelet
Dog Tag
If Bracelet, Check Which Model SE Series Silver
SE Series Gold
SE Series Mixed
OE Series Silver
SE Series Gold
SE Series Mixed
If Bracelet, Wrist Size