Digital Scan Upload

Clear Aligner Case RX

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Doctor Name*

First NameLast Name
Direct Contact Email*
Please provide an email that is checked frequently.
Direct Contact Phone Number*
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Patient Name*

First NameLast Name
Specify any Special Instructions
Please specify instructions here.
Complete Single Arch Only (Lab Design & Fabricate)Complete U+L Dual Arch (Lab Design & Fabricate)Clear Aligner Design Only (Doctor Fabricate In-office)Fabrication of existing .stl filesCase EVALUATION ONLYOther
REQUESTED RETURN DATES*

MonthDayYear
Date
Upload File

You can upload any type of file. Max: 300 MB
Cancelof
The calendar date is the date you would like your case back in your office.

Turn Around Times:

Please allow 14 days for complete aligner cases.

Please allow 7 days for fabrication-only aligners.
Please be sure to upload all files relevant to this case.

Clear Aligners must have:
1. U & L Scans
2. R & L bite scans or full bite scans (preferred)
3. Ortho Photos
4. Panorex
**Scans must be clear and without artifacts or distortions**
Signature

The state of Florida Dept of Health REQUIRES a dentists signature for all dental lab cases.
Should be Empty:

Clear Aligner Case RX