A WIN-WIN
SITUATION!
Take this coupon with you when you visit your
family dentist for your regular hygiene appointment.
Have your hygienist fill it out for you and send or
bring it back to Dr. Bourne’s office.
YOU AND YOUR HYGIENIST WILL BOTH
BE ENTERED IN OUR “WIN-WIN CONTEST”
IF YOU ARE CAVITY FREE.
Winners are drawn once a month!
Don’t Forget - Your Smile
Will Be A Winner Too!
Jason R. Bourne, DDS, MS
9633 Market Place, Suite 104 • Lake Stevens, WA 98258
P: (425) 334-4053 • F: (425) 334-8387
815 State Avenue, Suite 3 • Marysville, WA 98270
P: (360) 659-0211 • F: (360) 658-0716
www.BourneOrthodontics.com
FILL OUT THIS FORM AND RETURN TO OUR OFFICE
TO WIN A GREAT PRIZE FOR BOTH OF YOU!
Patient’s name:___________________________
Phone number:___________________________
Date of hygiene visit:_______________________
Hygienist’s name:_________________________
Office of Dr.:_____________________________
Hygienist signature:________________________
Hygiene comment :________________________