Teeth 2 Go Order form

Disclaimer:

This form should be completed and submitted in one session. You will not be able to continue filling this form on another device.
Teeth 2 Go Order form
Profession
Name

Last NameFirst Name
Dental Clinic Name

Clinic Name

Street Address

CityState

Zip code
Phone Number

Country CodeArea CodePhone Number
Country
Design Due date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email address
Have you purchased any TRI Dental Implants products in the past?
Please enter your TRI Dental Implants customer number:
Case Instruction
Dental Clinic Case ID
e.g. patient last name - this allows to identify the work precisely back to you
Number of implant units in the design
Teeth2Go conversion for
CAD software used to design
Indicate matrix® platform and pontic

Upper arch: Please type "37 or 45" for platform and "P" for pontic

Rows	17 (2)	16 (3)	15 (4)	14 (5)	13 (6)	12 (7)	11 (8)	21 (9)	22 (10)	23 (11)	24 (12)	25 (13)	26 (14)	27 (15)
Type: P37, P45, "P" pontic

Upper arch: For the best milling result possible, please type "37 or 45" for platform and type "2.8L. 2.8 or 2.6" for screw used in your design

Rows	17 (2)	16 (3)	15 (4)	14 (5)	13 (6)	12 (7)	11 (8)	21 (9)	22 (10)	23 (11)	24 (12)	25 (13)	26 (14)	27 (15)
Type: P37, P45, "P" pontic

Lower arch: Please type "37 or 45" for platform and "P" for pontic

Rows	47 (31)	46 (30)	45 (29)	44 (28)	43 (27)	42 (26)	41 (25)	31 (24)	32 (23)	33 (22)	34 (21)	35 (20)	36 (19)	37 (18)
Type: P37, P45, "P" pontic

Lower arch: For the best milling result possible, please type "37 or 45" for platform and type "2.8L. 2.8 or 2.6" for screw used in your design

Rows	47 (31)	46 (30)	45 (29)	44 (28)	43 (27)	42 (26)	41 (25)	31 (24)	32 (23)	33 (22)	34 (21)	35 (20)	36 (19)	37 (18)
Type: P37, P45, "P" pontic

USD

Credit card information