Member registration

MAGFIT Network Member Application Form

We're committed to protecting your right to privacy. All information submitted will be used solely for the MAGFIT Network purposes and will not be disclosed to any third parties.

Content of inquiry

Please fill in the information in all the required fields marked with an asterisk *

*Last Name :

*First Name :

*Clinic / Hospital Name :

*Postal Code :

*Country :

*City :

*Mailing address :

*Telephone :

Fax :

*E-mail :

If you are already a MAGFIT user,
please tell us where you have been purchasing MAGFIT from

Distributor Company Name :

Telephone :

Representative Name :

Please choose from the following which best describes you:

Clinical Experience with Magnetic Attachments

I have no previous experience with magnetic attachments, but I would like to start using them in my clinical cases.

I have previous experience with dental magnetic attachments. (Please continue and fill in below)

For previous dental magnetic attachments users

Clinical Experience

How many magnets do you used in a year?

Satisfaction Rating for Magnetic Attachments

Which type of treatment do you apply magnets to the most?

Partial DenturesFull DenturesImplant-supported Overdentures
Other
Please describe