Please complete this short form to receive The Probe free of charge

Please note - All fields marked * are mandatory

Please send me each issue of The Probe free of charge*
Yes No

Please select a preferred format*
Print
Digital when available
Both

Title

  if other *
First Name

*
Surname

*
Job Title (in full)
Department
Company Name

*
Address line 1

*
Address line 2

Address line 3

City

*
County / state
Postcode / zip

*
Country

*
Work Tel

*
Work Fax
Work Email

*

Please help us to comply with ABC regulations and ensure you get a regular copy by telling us the month of your birth  *

Your information will be handled in accordance with the UK Data Protection Act 1998. By providing us with your e-mail, phone & fax, you consent to being contacted occasionally by us about your magazine subscription or related products. Your details may also be released occasionally to carefully selected 3rd parties. Should you not wish to hear from other organizations, please write to the Database Manager, IPG, PO Box 121, London SE20 8QZ United Kingdom.

Q1. What is your job title? *
01 Dentist
02 Practice Manager
03 Dental Therapist
04 Dental Hygienist
 06 Dental Technician
07 Dental Nurse
05 Other (please specify)
 
Q4a. If you are a dentist which of the following best describes your main employment? *
01 General Practice Principal/Partner
02 General Practice Associate
03 General Practice Salaried 		04 Vocational Trainee
05 Other Salaried
Q4b. How many professionals are there in your practice? *
Dentists
Hygienist
Nurse
Other
 
Q5. Approximately what percentage split best describes your NHS/Private Patients? *
01 100% NHS
02 80% NHS 20% Private
03 60% NHS 40 % Private 		04 40% NHS 60% Private
05 20% NHS 80% Private
06 100% Private
Q6. Which of the following treatments does your practice offer to patients? *
01 Implant Placement
02 Implant Prostheses
03 Endodontics
04 Periodontics
05 Full Dentures
06 Domicillary Care
07 Amalgam Fillings
08 Aesthetic/Cosmetic Dentistry
09 Dentistry for the aged
11 Minor oral Surgery
12 Relative Analgesia
 13 Intravenous Sedations
14 General Anaesthesia
15 Removable Orthodontics
16 Functional orthodentics
17 Fixed orthodontics
18 Children’s Dentistry
19 Veterinary Dentistry
20 Dentistry for severely mentally and/or physically            impaired
21 Other (please specify)
 

Thanks for your time. We look forward to keeping you up to date with The Probe Magazine.