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Grin Professional Community New Zealand
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* Indicates required question
Email
*
Your email
Full name
*
Your answer
Phone number
*
Your answer
Name of your practice
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Your answer
What is your practice specialised in? ( Please select one or more)
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Diagnostic and Preventative
Pediatric
Endodontic
Cosmetic
Periodontal
Orthodontic
Prosthodontic
Oral and maxillofacial surgery
Other:
Required
On average, how many patients does your practice treat per week?
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Your answer
On average, how many patients visiting you are children 7 and under?
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None
Less than 20%
Between 20% to 50%
More than 50%
Required
What oral care brands do you stock at your practice? Please note NA if stock none.
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Your answer
Would you stock fluoride-free natural toothpastes at your practice?
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Yes, I would stock fluoride-free adult natural toothpastes
Yes, I would stock fluoride-free kids natural toothpastes
Yes, both
No, I only stock fluoride toothpastes
Required
What Grin products are you looking at stocking at your practice?
*
Adult natural toothpaste
Kid natural toothpastes
Adult biodegradable floss picks 45pk
Kids biodegradable floss picks 45pk
Adult charcoal-infused biodegradable toothbrushes
Kid charcoal-infused biodegradable toothbrushes
Grin On the Go (travel set)
1-2-3Grin! Kid Oral Care Set
Other:
Required
What is your postal address for receiving your Grin samples?
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Your answer
We'd love to hear a bit more about yourself and why you'd love to stock Grin at your practice?
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Your answer
How would connect Grin with your patients?
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I want to stock and sell Grin at my practice.
I want to gift Grin to my patience after their treatment.
I want to enclose Grin in a gift box for special events
I want to distribute Grin in my area
Required
Would you be happy to share with us your primary social accounts? Please specify your account handles/ links here (Instagram/FB/Youtube/Website). Please use NA if you aren't active online.
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Your answer
Would you be happy to endorse Grin on social channels and/or blogs/Medias?
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Yes, social channels (one or more channels from answers above)
Yes, blog article
Yes, media channels
No
Required
We're excited to have your interest in stocking Grin at your practice. Any other ideas on how we can best support your community moving forward?
Your answer
Thank you for your time! We will be in contact via email within 3 business days. If you have any questions, please email Jackie at
professionals@grinnatural.com
:)
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