Clone of Paradigm - Submit Grammetry Case

Doctor Name*
Patient Name*
Email*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Prosthetic design preference*
Tooth Shade*
Other
Tissue Shade*
Arch*
Screw Brand*
Include Screws?*
Do you need a driver?*
How are you submitting your files?*
IOS Portal*
Name of other IOS
Turnaround Time:

It will take 8 days in lab upon either digital receipt or physical receipt of all appropriate records.
Case Notes
Patient Files*

Cancelof
Should be Empty: