NavaGation Guided Surgery & Latched Conversion

We've updated our submission process! Please click the link below to visit our new submission portal.
Please click here to submit your case.
NavaGation Guided Surgery & Latched Conversion
Doctor *

First Name Last Name
Patient Identification Code (PIC) *
Required for case communication to maintain HIPPA compliance. Please enter existing PIC (already used within your office). Or Create a 5-7 digit code (alpha & numerical) Example: Pt. John Doe = D13578
Patient Name

First Name Last Name
Phone Number *

Area Code Phone Number
Location *
Need to Submit Dicom *

Yes No
DICOM Upload *
Model *

Uploading Model Sending Stone Models
Upper Scan STL
Lower Scan STL
Bite Scan STL
Denture/Dual Scan *

Yes No
Denture Scan 1 (.stl or dual-scan)
Denture Scan 2
STL Guide
Photographs - Retracted | High and Low Smile| Profile

Upload Files

Cancel of
Smile Simulation Prevu
Please Provide Full Face Picture with Natural Smile
Shade
Arches *

Maxillary Mandibular Dual-Arch
Impressions/Models *
Guided Kit *
Implant Brand *
Clinical Support

Chair side support No chair side support
If you are a new customer please select yes and fill in the following
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Agree to terms and conditions of order *

I have read, understand and agree to the terms and conditions of ordering products using this form.
We guarantee delivery of a NavaGation case 10 business days after case review and approval is received from surgeon.

Please do not schedule your surgery date until this review is completed!
Additional Notes
Should be Empty:

We've updated our submission process! Please click the link below to visit our new submission portal.

NavaGation Guided Surgery & Latched Conversion