THANKS FOR YOUR ORDER! LET'S CONFIRM YOUR ORDER.
PLEASE DOUBLE CHECK YOUR SELECTIONS TO AVOID DELAYS! TAKE YOUR TIME, READ, BREATHE AND TAKE IT ONE STEP AT A TIME!
Is this your first time filling out this form?
*
Yes
No
If you’ve filled this form before, tell us what you want to change. We move fast and start your order right away, so changes may not make it in time.
By confirming your order, you acknowledge that once your PMG is crafted according to your confirmation, you assume responsibility for any accidental discrepancies or changes.
*
Agree
Back
Next
Please write the full name you used on your order. If you bought one for someone else, use their name for their own separate form.
*
First Name
Last Name
ORDER NUMBER - 4 DIGITS ONLY
*
Back
Next
DETAILS FOR PURCHASED PROTECTIVE MOUTH GRILL ONLY.
Kindly leave out any details for the free PMG in this section. You'll have a chance to include that information later in the confirmation process. Right now, this section is just for the main grill you purchased.
Please confirm which TOP teeth you want to cover for the grill you purchased (not the free gift). Make sure it matches your original order. If you want to make any changes, there will be an extra cost.
*
TOP - R8
TOP - R7
TOP - R6
TOP - R5
TOP - R4
TOP - R3
TOP - R2
TOP - R1
TOP - L1
TOP - L2
TOP - L3
TOP - L4
TOP - L5
TOP - L6
TOP - L7
TOP - L8
NONE
Please confirm which BOTTOM teeth you want to cover for the grill you purchased (not the free gift). Make sure it matches your original order. If you want to make any changes, there will be an extra cost.
*
BOTTOM - R8
BOTTOM - R7
BOTTOM - R6
BOTTOM - R5
BOTTOM - R4
BOTTOM - R3
BOTTOM - R2
BOTTOM - R1
BOTTOM - L1
BOTTOM - L2
BOTTOM - L3
BOTTOM - L4
BOTTOM - L5
BOTTOM - L6
BOTTOM - L7
BOTTOM - L8
NONE
Choose the color for your main order only. Make sure it matches what you purchased. If you want a different color or anything extra, there will be an additional fee
*
Please Select
NATURAL SILVER
GOLD
ROSE GOLD
WHITE GOLD
METALLIC
RHODIUM
Choose the metal type for your main order only. Make sure it matches what you purchased. If you want a different metal or anything extra, there will be an additional fee.
*
Please Select
SILVER925 BASE
10KT
14KT
18KT
Choose the style for your main grill (the one you paid for) and tell us exactly which teeth you want covered and with what design. For example: “L2 - Open.” We’ll match it as closely as possible, but small differences might happen. Just make sure you pick what you originally ordered. If you want to add anything new, there’ll be an extra charge.
*
EXAMPLE: L2 - OPEN (VERY THIN), L1 - STAR DESIGN
Choose the style for your main grill (the one you paid for) and tell us exactly which teeth you want covered and with what design. For example: “L2 - Open.” We’ll match it as closely as possible, but small differences might happen. Just make sure you pick what you originally ordered. If you want to add anything new, there’ll be an extra charge.
*
Your PMG will be custom-made by our jeweler and will NOT be an exact copy of the inspo photo—each piece is unique. If you have specific design requests, upload a clear inspiration photo. We will match it as closely as possible, but understand that variations will occur.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Did you pay for any upgrades on your free PMG?
*
Yes
No
If your order includes a free PMG, please choose which teeth you want to cover. You can choose OPEN or SOLID for each tooth right next to one another. You may purchase upgrades below. If this does not apply to your order, please write N/A.
*
EXAMPLE: R1 - OPEN (THIN), R2 - SOLID
Your free PMG is automatically placed on the same row as your original order. However, if you’d like it on a different row, please let us know. Keep in mind that to make this change, you’ll need to complete a new dental impression and molding kit for the correct placement.
*
Free PMG on Top
Free PMG on Bottom
No Free PMG
Back
Next
Can you smile really big and show your gums (the pink part above your teeth)? We need a close-up picture of that so we can check if it looks like your mouth model. It's kind of like taking a picture of your smile to see if everything is the same!
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you have a chipped or missing tooth that you're attempting to cover with your PMG?
*
Yes
No
Email Address on order
*
example@example.com
Back
Next
Preview PDF
Submit
Should be Empty: