INFO REQUEST

Please tell us about yourself and feel free to send us any comments or suggestions. If you would like more information about our future products/services, please complete the form below and we will add your name to our database to contact when more information is available. If you would like to ask Dr. Ruddle a technical question, please refer to the FAQs and Submit Question.

Background Information:

Name

First

Middle Initial

Last

Degree

Address

City

State

Zip

Country

Phone

Fax

Practice Information

GP Year Graduate

What % of your practice is endodontics?

ENDO Year Graduate

Other Specialty

What % of your practice is:

Shape-Clean-Pack (SCP)

Nonsurgical Retreatment (RETX)

Surgery (SURG)

What do you enjoy doing most?

What is the most frustrating?

Comments / Suggestions

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