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Invisalign Additional Scan
Patient Information
First and Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Cell Phone
*
-
Area Code
Phone Number
What tray number are you wearing now?
*
Are your current trays fitting?
Yes
No
How often do you switch trays?
Every Week
Every 10 days
Every two weeks
As needed
Other
Please feel free to include a picture of the fit of your trays.
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Would you like to continue treatment with an Invisalign scan or are you ready to discuss retainer options?
Invisalign Additional Scan
Discuss Retainer Options
How satisfied were you with this set of Invisalign trays? Please explain.
What goals are you looking to accomplish in your upcoming set of Invisalign trays? Please explain.
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