Full Name *

Email *

Phone *

Organization *

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How satisfied are you with your AG support? (1-5 scale ) ........ (1 = worst, 5 = best))

Did your current/last distributor's support meet your expectations?

Would you like to receive AG Ceramill Support provided through DENTwire / Dicks Dental? *

Rate support received by DENTwire / Dicks Dental (Richard Jentsch) (Scale of 1 to 5)

Rate DENTwire's response time (e.g., responsiveness and time until your issue was resolved). (Scale of 1 to 5)

Rate the communication received by DENTwire / Dicks Dental (Richard Jentsch) (Scale of 1 to 5)

How likely are you to recommend DENTwire / Dicks Dental's services to others? (Scale of 1 to 5)

Do you have any additional comments, feedback, or suggestions?

I agree to terms & conditions provided by the company and to forward my information to others (AG). By providing my contact information, I agree to receive text messages, emails and phone calls from the businesses (DENTwire, LLC / Dicks Dental & in extend AG, otherwise known as Amann Girrbach).