Request Donation of Consumer Dental Products
We are happy to donate dental supplies to charitable programs in our community. If you are a representative of an organization or program which seeks to acquire such supplies, you may submit a request using the form below.

Please understand:
1. Incomplete forms cannot be processed
2. Supplies are limited, and requests may thereby be denied
3. A minimum of 25 people must be served by the event
4. It may take up to two weeks to process your request
5. Supplies cannot be delivered
6. Requests cannot be submitted by phone
7. Mouthwash may contain alcohol, and should be dispensed accordingly
8. All items are small or travel sized

Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.