DUO Sensor Trial Request

Contact Details

Full Name *

Title *

Practice Name *

Email *

Preferred Phone *

Mobile Phone

Business Shipping Address

Address *

City *

State *

Postal code *

Country *

DUO Sensor Size *

Size 1

Size 2

What Digital Imaging Software Do You Use? *

Dexis Imaging

Dentrix Ascend Imaging

None

Other

* This is a request for a 14 day trial use of the DUO Sensor. We will assist you in the installation and operation of this sensor, after which you will have 14 days to use and evaluate it in your practice. When the trial period has ended, please repackage the sensor and all accessories into the same packaging it arrived in, affix the included return shipping label, and return the sensor. Upon receipt and inspection of the returned sensor, you will receive a confirmation email, and the security hold will be released from the card on file (this may take 5-7 days depending on your bank). If you decide to purchase the DUO Sensor while you are in possession of the trial sensor, we will ship the new sensor to your office through a separate transaction, and you will be able to continue using the trial sensor until the new one is received. At that point you will return the trial sensor and accessories in the original packaging. If the trial sensor is not returned within 21 days after trial ending, your credit card will be charged the remaining balance due for the sensor purchase. If the trial sensor should get damaged or malfunction while in your possession, it is your responsibility to contact us immediately so that we can assist you, and the customer may be responsible for repair or replacement costs.