Registration

Please note that if you already have a Colgate Professional Account, you simply need to login with your existing username and password. Click Here to login.

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Enter Your Information

Profession Type*

First Name*

Last Name*

E-Mail*

Confirm E-mail*

Password*

Confirm Password*

Password should be at least 6 characters long and contain at least one number, capital letter or special character.

Mobile Number*

Account Number

Student Information

Expected Graduation Date (if applicable)

Month*

Year*

Professional Information

State Where Licensed*

License Number*

Highest Level of Education*

Business Information

Contact Information

Dental Practice Name*

Dentist Name*

School / Institution Name*

My school is not in this list

(Home Address)

Street Address*

Street Address 2

City*

State*

Zip Code*

Phone*

Add Additional Address Information

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Yes, I am a registered dentist or hygienist with a license to practice in the United States.

Questions? Email our COHA Membership Manager: sherry@cohaadvisor.com or call toll-free: (855) 238-2485