Interested in making a donation to the Sindecuse Museum of Dentistry? Please take a few moments to provide us with information about your object(s). This information is vital for helping us to fully document artifacts in our collections and to use them in our exhibitions, so please fill out all information you know. Thank you for your time and effort in completing this form.

Name

First Name

Last Name

Email Address

Phone

Object

How long have you owned the object?

How did you acquire it?

Purchase

Inheritance

Gift

Found

Other

Who made the object?

When was it made/purchased?

Where was it made/purchased?

Of what materials is it made?

Select

Did you perform any repairs or make any changes to it while it was in your care?

If yes, please explain:

How was it used?

Who used it?

When was it used?

Additional comments