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Role Type^*

Specialty^*

Are you currently using and/or recommending Crest and Oral-B products? (select all that apply)^*

Using Crest toothpaste

Using Oral-B Manual toothbrush

Using Oral-B Electric Rechargeable toothbrush

Recommending Crest toothpaste

Recommending Oral-B Manual toothbrush

Recommending Oral-B Electric Rechargeable toothbrush

None of the above

Is your dental practice currently being visited by a Crest / Oral-B representative?^*

Role Type^*

Area of Study^*

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School Name (Can't find your school in the list? Please select Other by typing "O")^*

Graduation Date (or Completion Date)^*

Are you currently using and/or recommending Crest and Oral-B products? (select all that apply)^*

Using Crest toothpaste

Using Oral-B Manual toothbrush

Using Oral-B Electric Rechargeable toothbrush

Recommending Crest toothpaste

Recommending Oral-B Manual toothbrush

Recommending Oral-B Electric Rechargeable toothbrush

None of the above

Is your dental school currently being visited by a Crest / Oral-B representative?^*

School State^*

Role Type^*

School Name (Can't find your school in the list? Please select Other by typing "O") ^*

Department^*

Status^*

Are you currently using and/or recommending Crest and Oral-B products? (select all that apply)^*

Using Crest toothpaste

Using Oral-B Manual toothbrush

Using Oral-B Electric Rechargeable toothbrush

Recommending Crest toothpaste

Recommending Oral-B Manual toothbrush

Recommending Oral-B Electric Rechargeable toothbrush

None of the above

Is your dental school currently being visited by a Crest / Oral-B representative?^*

Is your dental practice currently being visited by a Crest / Oral-B representative?^*

Role Type^*

Job Title^*

Organization Name^*

Are you currently using and/or recommending Crest and Oral-B products? (select all that apply)^*

Using Crest toothpaste

Using Oral-B Manual toothbrush

Using Oral-B Electric Rechargeable toothbrush

Recommending Crest toothpaste

Recommending Oral-B Manual toothbrush

Recommending Oral-B Electric Rechargeable toothbrush

None of the above

Role Type^*

School Name &/or Number^*

District Name &/or Number^*

State^*

School Type^*

Grade^*

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