"The Best Topical - Ever!" - Toll-Free CALL: 1-888-986-7422
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**GOOD NEWS**
TheBestTopicalEver! is back in stock-
all flavors are available.
Please fill out the order
form below for prompt shipment.

Kindly note that only US licensed prescribers
can order TheBestTopicalEver.
In addition,  we can only ship to
confirmed business addresses within the USA.
 
 
Online order by completing the Dentist Information Form then order below.
 
Thank you.
 
DENTIST/ DOCTOR INFORMATION FORM
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How did you hear about us? (If referred, please let us know that person's name and contact, so that we may send a thank you note.)
Full Name of Dentist:
Designation:
D.M.D.
D.D.S.
M.D.
DEA No.:
Licence No.:
Licence State:
Office / Clinic Name:
Office Telephone:
Office Fax:
Contact Person & Position:
Cell Phone (Alternate Telephone):
Email:
OFFICE/CLINIC ADDRESS:
NOTES / COMMENTS: