Clone of Paradigm - Submit Grammetry Case

Surgeon Name*
Patient Name*
Surgeon Email*
Surgeon Phone Number*
Surgeon Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who is responsible for the Restorative Package costs?*

SurgeonReferring Doctor
Referring Doctor Name*

First NameLast Name
Referring Doctor Phone Number*
Please enter a valid phone number.
Referring Doctor Email*
example@example.com
Day-of-Surgery Immediate Load
Which Paradigm Restorative Package are you submitting?*

Restorative Lab Package - ROE designs and fabricatesRestorative In-House Package - ROE designs and Doctor prints in-house
Have you pre-booked design services?*

Yes, I have pre-booked resourcesNo, I have NOT pre-booked resources. I will call ROE to confirm available resources (800-228-6663)
In order to guarantee a 1-hour turnaround time you need to have pre-scheduled planning resources 48 hours in advance. If you have not done so call us 800-228-6663 to confirm available resources.
Arch*
Which Photogrammetry / Grammetry Option?*
Scan Body Type
Other
Email to send files*
Prosthetic design preference*
Tooth Shade*
Tissue Shade*
Screw Brand*
Include Screws?*
Do you need a driver?*
Healing Collar Brand*
Other
How are you submitting your files?*
IOS Portal*
Name of other IOS
Case Notes
Patient Records*

Cancelof
Should be Empty:

Day-of-Surgery Immediate Load