Complete the form below to submit your case! If you have any questions please feel free to contact us for assistance.

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Date *

Dentist Name *

Dental Clinic Name *

Email *

Phone Number

Appliance: Removable

• Special Tray
• Wax Bite
• Try-in
• Re-set
• CrCo
• Dentures
• Valplast

Appliance: Crown & Bridge

• E-MAX
• Zirconia
• Inlay/Onlay/Veneer
• Implant/Bar/Attachment
• All on x
• PFM

Shade

If All-On X, explain here (Optional):

Case Instruction Description (Optional):

Preferred Due Date: (Note: We will contact you if we are unable to make at your preferred date)

How would you send the file? (Note: Our username and emails are next to selection)

• 3 Shape (Username:....., E-mail:......)
• Trios
• Medit
• iTero
• Cerec Sirona
• Google drive / One drive / Dropbox
• Wetransfer

Note: If you send the file via google drive/ one drive/ dropbox/ wetransfer, please copy and paste the link below.

Submit