Quadro Beta

Product Registration

Name *

First

M

Last
Practice Name *
Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email *
Phone Number *
Fax Number
Mobile Number
Website
Product Purchased
(select only one)
*











Serial Number *
Date Installed *

MM
/
DD
/
YYYY
Where did you purchase
your product?
*




Biolase Rep Name
Other (specify)
Dental School Attended *
Graduation Year *
Experience with Laser
Dentistry (select only one)
*

What types of procedures will you be using the product for? (select only one) *






Other
Who will be the primary
user of your new laser?


Other
Which of the following technologies does your practice now own?
(Check all that apply)






Please Check Box *
 I have read and understood the terms of the Limited Warranty for Biolase Lasers.

Read Warranty

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