Colgate

Welcome to the Colgate^® Prescription Pad Request Site

Did you know that pharmacies may dispense alternative high-ﬂuoride toothpastes?

Did you know that you can ensure your prescription is dispensed as prescribed? Here's how:

Write/Check the NDC code for one of the following ﬁve unique patented Liquid Gel 5000ppm formulas:

NOW AVAILABLE

PreviDent^® 5000ppm Kids
(1.1% Sodium Fluoride) Toothpaste
NDC: 0126-0311-92

Contains
Tricalcium
Phosphate

PreviDent^® 5000ppm Ortho Defense
(1.1% Sodium Fluoride) Toothpaste
NDC: 0126-0289-92

Contains
Tricalcium
Phosphate

PreviDent^® 5000ppm Booster Plus
(1.1% Sodium Fluoride) Toothpaste
Spearmint NDC: 0126-0074-92
Fruitastic NDC: 0126-0072-92

PreviDent^® 5000ppm Sensitive
(1.1% Sodium Fluoride and 5% Potassium Nitrate) Toothpaste
NDC: 0126-0070-61

SLS
free

PreviDent^® 5000ppm Dry Mouth
(1.1% Sodium Fluoride) Toothpaste
NDC: 0126-0016-61

PreviDent^® 5000ppm Enamel Protect
(1.1% Sodium Fluoride and 5% Potassium Nitrate) Toothpaste
NDC: 0126-0022-92

Mark
Dispense as Written (DAW), Brand Necessary, or your state-mandated equivalent

Order
your Rx pad today at colgateprevident5000.com

Designate
number of refills

Click here for full prescribing information.

If you prefer to dispense PreviDent^® 5000 in your practice, click here to order

Colgate^® PreviDent^® 5000 FREE Prescription Pad Request Form

Fields marked with * are mandatory. Based on state requirements we are no longer able to provide Rx Pads to California, Delaware, Florida, New Jersey, New York, Washington and Wyoming.

*Full Name:

*License Number:

*Practice Address:

*Email:

*Practice Telephone:

*PreviDent Kids Pads:

*Booster Plus, Sensitive, Dry Mouth and Enamel Protect Pads:

*Booster Plus Pads:

*Sensitive Pads:

*Dry Mouth Pads:

*Enamel Protect Pads:

*Ortho Defense Pads:

(Allow 2-3 weeks for delivery)