ACT for Professionals ACT Home Page ACT for Parents ACT for Professionals ACT Fluoride RInse ACT Rinse featuring SpongeBob SquarePants ACT Restoring Mouthwash ACT for Professionals Home Page Sanofi Aventis


Indications and Key Facts
Patient Compliance
Recommended Usage
Fluoride/Alcohol Content
Patient Education PDFs


Event Calendar
Wholesale Distributors
Request Samples
Contact Us

Request ACT® Coupons to Give to Your Patients



Please complete the following form to request ACT® coupon pads.
Coupon pads can only be shipped to addresses within the United States. We are unable to ship to PO Boxes. You will receive two coupon pads. Each pad contains 50 $1.00 coupons good on the purchase of ACT products. Limit two coupon pads per dentist every four weeks. Please allow 4-6 weeks for delivery.

Please enter your first name.
Please enter your last name.
Please enter your practice name.
Please enter a mailing address.
Please enter your city.
Please enter your zip code.Invalid format for zip code.
Please enter your medical license number.
A value is required.Invalid format.
A value is required.Invalid format.
A value is required.The values don't match.
   
Please select the following which best describes your position.





     If other, please explain.
 
Yes, I would like to join the ACT mailing list for future news, offers and/or product information.
   
Is yours a private practice?




 
Which brands do you recommend and/or sample?
(Check all that apply.)
     ACT Anticavity     
     ACT Anticavity Kids     
     ACT Restoring     
     ACT Total Care     
     Biotene     
     Crest Pro-Health     
     Crest Pro-Health
         Enamel Shield		     
     Listerine Antiseptic     
     Listerine Total Care     
     Listerine Smart Rinse     
     Oasis     
     The Natural Dentist     
     Tom's of Maine     
   
In the past 6 months, to what percentage of your patients have you specifically recommended a fluoride rinse?
(Please select one.)






   
In the past 6 months, for which of the following indications have you specifically recommended a fluoride rinse? (Check all that apply.)









   
 

 
ACT Fluoride Rinse   |   ACT Fluoride Rinse for Kids   |   ACT Restoring Mouthwash   |   ACT for Parents   |   ACT Home Page
©2010 Chattem, Inc. All Rights Reserved   |   Legal Notice   |   Privacy Policy   |   1-866-ACT-RINSE   
ACT Home Page ACT for Parents ACT for Professionals ACT Fluoride RInse ACT Rinse featuring SpongeBob SquarePants ACT Restoring Mouthwash ACT for Professionals Home Page ACT for Professionals Home Page