One Guide Order Form

Service Fee & Conditions* This field is required.The cost of the planning fee is $150. However the planning fee will be waived if the case is confirmed and the surgical guide template is made. 1) The planning fee will be charged if you would like to drop the case after receiving the surgical planning report. 2) The planning fee will be charged if there is no response or no confirmation within 60 days of receiving the surgical planning report.

Clinic Name* This field is required.

Doctor's Name* This field is required.

First Name

Last Name

Email Address* This field is required.(Surgical report will be sent to this email address)

example@example.com

Sales Representative Name* This field is required.

Order Product

Shipping Items for Order* This field is required.

CT Data

Order Sheet

Patient Oral Plaster Model (Including antagonist)

Oral Scanning Data

Check bite

Other

Shipping Date (If applicable)

Date

How to ship CBCT files* This field is required.If you need a courier pick up service, please contact your sales person or One guide team (02-9889-2675)

How to ship plaster models / Impression / STL* This field is required.If you need a courier pick up service, please contact your sales person or One guide team (02-9889-2675)

Product request date* This field is required.Surgical Plan and Guide Turnaround Times Standard Cases: 2–3 business days for the surgical plan, starting from the successful receipt of all required materials (CT scans and impressions, either stone model or intraoral scan file). Full Arch Cases: Up to 5 business days for the surgical plan after receipt of the same materials. Once the surgical plan is confirmed: Surgical Guide: Fabrication and dispatch will be completed within 3 business days following final confirmation. Temporary Crown Creation: This process may require an additional 1–3 business days. Please submit your request date at least 2–3 days prior to the surgery date to ensure timely preparation.

Date

Name of Partnet LinkPlease select one of following option.

3Shape Communicate

Medit Link

iTero MyAligntech

Sirona

Other

CT Scan (DICOM) File UploadPlease upload your DICOM file as a ZIP archive format. * The maximum file size that can be uploaded at once is 1000MB.

Drag and drop files here

Select files to upload

Max. file size: 1.0GB

Intra Oral Scan (STL) File UploadPlease upload your STL file as a ZIP archive format.

Drag and drop files here

Select files to upload

Delivery Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

Patient Information* This field is required.

Name of Patient

Gender

Age

Estimated bone density

Treatment Requirements

Initial fixation required

Immediate implantation after extraction

Other

Implant Site* This field is required.

Desirable Fixture specification

Tooth no

Diameter

Length(mm)

Fixture 1

Fixture 2

Fixture 3

Fixture 4

Fixture 5

Fixture 6

Fixture 1

Fixture 2

Fixture 3

Fixture 4

Fixture 5

Fixture 6

Tooth no

Diameter

Length(mm)

Tooth no

Diameter

Length(mm)

Tooth no

Diameter

Length(mm)

Tooth no

Diameter

Length(mm)

Tooth no

Diameter

Length(mm)

Tooth no

Diameter

Length(mm)

Select Fixture system

Make Temporary Tooth?* This field is required.

YESNO

Desired Temporary crown shade

Guide Hole TypePlease select your preferred guide hole type.

Close Type - Enough distance between jaws

Open Type - Short distance between jaws

Additional ComponentsSelect if needed

Healing Abutment

Cover Screw

N/A

Order for one arch?* This field is required.

YESNO

One Arch Order Policy

By submitting this order, you acknowledge and agree to the following terms and conditions:

1.Promotion Eligibility

Promotional pricing is only available to Gold Package members.
If you are not a Gold Package member, the promotion will not be applied.

2.No Cancellation or Refund

Once a One Arch case is submitted, the cost will be automatically deducted from your credit balance in advance.
Therefore, no cancellations, modifications, or refunds will be accepted under any circumstances after submission.

3.Warranty

The following warranty periods apply to restorations provided:

* Temporary crown: 1-month (30-day) limited warranty
* Final zirconia prosthesis: 1-year limited warranty
* Metal bar: Lifetime warranty

Any issues occurring after the respective warranty periods will not be covered.

By proceeding with this order, you confirm that you understand and accept the above terms.

Are you a Gold Package member?* This field is required.

YESNO

Dentist WhatsApp contact informationSurgical draft planning wil be sent via WhatsApp

Smile Line Photo

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Additional RequestsPlease specify if you have additional requests.

One Guide Order Form