Seoulalign Order Form

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Please enter your Seoulalign Doctor Code* This field is required.same as MCHK Medical Practitioners Registration No.

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Clinic Emailto be confirm order by email

example@example.com

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Patient Full Name* This field is required.

First Name 名

Last Name 姓

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Patient Gender* This field is required.

Male

Female

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Patient Date of Birth* This field is required.

Date

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Teeth Photo Upload

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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3D Scan File Upload* This field is required.(.stl file only)

Drag and drop files here

Select files to upload

Min. file size1.0KB, Max. file size: 97.7MB

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X-Ray Upload (if any)(.png recommended)

Drag and drop files here

Select files to upload

Max. file size: 9.8MB

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Which service do you require?* This field is required.

Aligner

Retainer

Model

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Expected Delivery Date* This field is required.Minimum 4 working days from date of form submission.

Date

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Upper Arch. (Estimate no. of steps)e.g. Close spaces from #12-#22, align lower arch

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Lower Arch. (Estimate no. of steps)e.g. move #31#32 by 0.5mm

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Thickness* This field is required.(Default 0.5 mm for Aligner)

0.5 mm (Standard)

0.7 mm

1.0 mm

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Trim Line Margin* This field is required.(Default 2.0 mm for Aligner)

2.0 mm

1.5 mm

1.0 mm

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Labial Margin* This field is required.

Curved

Scalloped

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Lingual Margin* This field is required.

Curved

Scalloped