Keep Your Clinic Calm

Never miss another refill!

Diffuser Refill Reminder Sign-Up

Please tell us about your diffuser and how you would like to be contacted below. If you want to schedule more than one reminder for multiple diffusers or multiple installation dates, you will be given the option at the end of this form.

Email Address

First Name

Last Name

Product

Date Installed

Nickname (ie: Exam Room A, Lobby, etc)Add a nickname to your refill reminder for easy reference later.

Clinic or Organization Name

Address

City

State

Postal Code