ORDER FORM

Download Order Form Here OR click order form below to print

Prophy Power Order Form
Procedure: Clean and sterilize instruments. Make a list of the quantity and what points you want. Include Doctor’s name, office address and phone number. Verify that you have sterilized the instruments by drawing a happy face on the outside of the box. Thank you!

Send to:
Prophy Power
33469 – 137th Lane
Montgomery, MN 56069

order_form

Download Order Form Here OR click order form to print