2024 HOLIDAY GIFT Official Redemption Form

Refund Offer Terms and Conditions: This offer is only valid for dental treatment completed between October 15 and December 6, 2024. Limit of one (1) redemption request per patient. Limit of three (3) gifts per household. Dental treatment must be completed by December 6, 2024. This offer is not redeemable with any other promotion or offer. No cash refunds. No exchanges. Triangle Family Dentistry reserves the right to modify or discontinue this offer at any time for any reason. All requests must be received before December 31, 2024. The redemption form below must be filled out and submitted. A prepaid card is subject to the terms and conditions of the issuer.

Which Holiday Gift do you prefer (Please choose one): *

Sonicare toothbrush

E- Gift Card ($25 – $100)

Must select only one. If no selection, Target will be processed *

Door Dash

Target

Amazon

How to receive your Holiday Gift:
▪ Contact Triangle Family Dentistry to schedule your dental treatment appointment before December 6, 2024
▪ Complete the form below

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Date Treatment Plan Completed: *

In which Office are you a Patient: *

Offer Valid: 10/15/24 through 12/6/24
Forms must be received by 12/31/24

See Terms and Conditions Above

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