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*
Email address*
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

	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

	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

	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

	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

Upload stl file of your design for conversion*

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Additional Notes
Total
Credit card information

The credit card will not be charged until the delivery of the job

Credit card information