Welcome to the Colgate® Prescription Pad Request Site

Did you know that pharmacies may dispense alternative high-fluoride toothpastes?

Did you know that you can ensure your prescription is dispensed as prescribed? Here's how:

Write/Check the NDC code for one of the following five unique patented Liquid Gel 5000ppm formulas:

NOW AVAILABLE

PreviDent® 5000ppm Kids

(1.1% Sodium Fluoride) Toothpaste
NDC: 0126-0311-92
Contains
Tricalcium
Phosphate

PreviDent® 5000ppm Ortho Defense

(1.1% Sodium Fluoride) Toothpaste
NDC: 0126-0289-92
Contains
Tricalcium
Phosphate

PreviDent® 5000ppm Booster Plus

(1.1% Sodium Fluoride) Toothpaste
Spearmint NDC: 0126-0074-92
Fruitastic NDC: 0126-0072-92

PreviDent® 5000ppm Sensitive

(1.1% Sodium Fluoride and 5% Potassium Nitrate) Toothpaste
NDC: 0126-0070-61
SLS
free

PreviDent® 5000ppm Dry Mouth

(1.1% Sodium Fluoride) Toothpaste
NDC: 0126-0016-61

PreviDent® 5000ppm Enamel Protect

(1.1% Sodium Fluoride and 5% Potassium Nitrate) Toothpaste
NDC: 0126-0022-92

Mark
Dispense as Written (DAW), Brand Necessary, or your state-mandated equivalent

Order
your Rx pad today at colgateprevident5000.com

Designate
number of refills

Click here for full prescribing information.

If you prefer to dispense PreviDent® 5000 in your practice, click here to order

Colgate® PreviDent® 5000 FREE Prescription Pad Request Form

Fields marked with * are mandatory. Based on state requirements we are no longer able to provide Rx Pads to California, Delaware, Florida, New Jersey, New York, Washington and Wyoming.
(Allow 2-3 weeks for delivery)