We appreciate you as a customer and hope you will recommend us to your friends and family. As a way of saying thanks for helping spread the word about Pediatric Dentistry of East Texas we want to offer you a free gift certificate! Here's what to do:

• Tell your friends about us and ask them to call for an appointment at (936) 634-6119
• Fill out the form below with you and your friend's contact information
• When your friend comes in for an appointment we will send you the gift certificate you chose

Your Info
Full Name
Email Address
Phone
Current Address	Street Address; City, State, Zip

Your Friend's Info
Friend's Full Name
Friend's Child Name
Email Address
Friend's Phone

Choose your Gift Certificate:	$25 Chilis $25 Red Lobster $25 Casa Ole
Comments
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