Product Registration

For our customers that have recently purchased Physics Forceps, please complete the following form to register your product warranty. The intent of the Product Registration and associated questionnaire is to ensure you have watched the training video and are properly using the Physics Forceps. All warranties are null and void without Product Registration.

*Dr. Name *Practice Name Address City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip County United States Canada Mexico Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Terr. Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands/Malvinas Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Is. Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Lao People's Dem. Rep. Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Is. Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia St. Vincent & Grenadines Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa S.Georgia & S.Sandwich Is. Spain Sri Lanka St. Helena St. Pierre & Miquelon Sudan Suriname Svalbard & Jan Mayen Is. Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom U.S. Minor Outlying Is. Uruguay Uzbekistan Vanuatu Vatican (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis & Futuna Is. Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe *Telephone Fax Web Address *Email *Enter code 1. All multi-rooted teeth have to be sectioned in order for the Physics Forceps® to work properly? True False 2. The harder you squeeze the instrument on the tooth, the easier it will work? True False 3. The bumper is placed on the tooth before the beak is placed? True False 4. There is no need to remove buccal tooth structure with a flame shaped diamond if you think the buccal bone will fracture? True False 5. Root tips under the gum cannot be extracted with the Physics Forceps®? True False 6. The upper anterior forceps can be used on the lower teeth since it looks similar? True False 7. The farther down the root the beak of the instrument is placed, the more difficult the tooth is to remove? True False 8. Buccal bone will never break or fracture if you squeeze the instrument and move your arm? True False 9. The greater the distance between placing the beak and the bumper has no effect on the outcome of the extraction? True False I have viewed the enclosed training video in its entirety prior to performing any extractions.