Scan&Smile Surgical Guide

Disclaimer:

This form should be completed and submitted in one session. You will not be able to continue filling this form on another device.
Scan&Smile Surgical Guide
Dr. First and Last Name

First NameLast Name
Dental Clinic Name

Clinic Name

Delivery Address

CityState

Zip Code
Phone for any issues / question arises

Country CodeArea CodePhone Number
Country
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dental Clinic Case ID
e.g. patient last name - this allows to identify the work precisely back to you
E-Mail to receive STL files and for us to contact

Confirmation Emailexample@example.com
Design Due date and time (in your time zone)

MonthDayYear
Date
Hour MinutesAM/PM Option
US Timezone
Write your timezone
Have you purchased any TRI Dental Implants products in the past?
Please enter your TRI Dental Implants customer number:
Guide design preferences
Surgical Design for
Number of Implants in the Case
Guide Design
Technical information and any requests you would like to instruct
Tell us more about the case and your design preferences
Load required files up on booking

Cancelof
Pre-op I/O Scans

Cancelof
Promocode
calculation

USDDescription

Guide design preferences