Sample Request Double Nasal Hoods Sample Request Thank you for your interest in Air Techniques’ Disposable Nasal Hoods. Please fill out the sample request form below to receive one pediatric (Strawberry Delight) and adult (Blueberry Dance) hood. Send sample to: * RequiredRole*Select a TitleDDSDMDRDHDHDAOTHERFirst Name* Last Name* Dental Specialty*Select a SpecialtyGeneral DentistEndodontistOrthodontistPeriodontistProsthodontistPediatric DentistOral SurgeonDental AssistantDental HygienistOffice ManagerDental StudentDealer RepresentativePractice Name Address* City* State*ALAKAZARCACOCTDEDistrict of ColumbiaFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip* Country*United StatesWork Phone*Mobile PhoneWork Email* My preferred dealer:*My preferred dealer:A-Dent Dental Equipment Inc.AM-TOUCH Dental SupplyAtlanta Dental SupplyBenco DentalBone-A-Fide Dental Sales & Service IncBurkhart Dental SupplyDarby Dental Supply LLCDental Fix / Dental WhaleDFC Dental Supply Inc.DHP Dental Health ProductsEquipment BrokersFitzpatrick Dental Equipment CompanyGoetze DentalHenry Schein CanadaHenry Schein DentalIQ DentalJ&B Dental ServicesJohnson & Lund Company Inc.Kings Two Dental SupplyM & S Dental SupplyMidco Dental Inc.Midway Dental Inc.Midwest DentalNashville DentalNewark/Pemco DentalParkway Dental ServicesPatterson CanadaPatterson DentalPearson DentalRedwood Dental SupplyReliable Dental Equipment GroupSafcoSinclair DentalTri-State Dental Supplies & EquipmentYaeger Dental Supply Inc.Name of Supply Rep How did you hear about this offer?*Please SelectWebsiteSocial MediaEmailDealer I would like to receive email notifications of news and promotions from Air Techniques. Sign up for text message updates and reminders. I work for the federal government or armed forces.