Submit a Case
Please only use this form if you wish for the Active Aligners UK team to upload a case on your behalf. If you would like to upload a case yourself, please log into the online portal: https://www.activealigners.co.uk/doctors-login/
Dentist's Name
*
First Name
Last Name
Patient's Name
*
First Name
Last Name
Practice's Name
*
Case Type
*
Anterior (5 to 5)
Full arch (7 to 7)
Refinement
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IPR Preference
Yes, first expansion and proclination then IPR
Yes, first IPR then try to avoid expansion and proclination
No IPR
Lower crowding
Lower crowding - IPR primarily
Lower crowding - expansion primarily
Upper crowding
Upper crowding - IPR primarily
Upper crowding - expansion primarily
Lower midline
Lower midline - maintain
Lower midline - move to patient's left
Lower midline - move to patient's right
Lower midline - improve
Upper midline
Upper midline - maintain
Upper midline - move to patient's left
Upper midline - move to patient's right
Upper midline - improve
Posterior crossbite handling
Maintain posterior crossbite
Correct premolars
Correct molars
Anterior posterior relation
Maintain anterior posterior relation
Improve canine relationship
Improve molar relationship
Improve canine and molar relationship
Retainers
*
Yes
No retainers needed
Original order ID (if a refinement case)
Design Instructions
*
I am sending impressions (not scans) for this case
*
I already have freepost envelopes
Please send me freepost envelopes
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