Request Form

Clinic

Dr.

Patient's Name

E-mail

Age

MaleFemaleOther

Scale

Tooth Colour

Type of work

If the work is Implantology, we need to know:
- Description of the implant(s) (Brand, platform...)
- Inform if the clinic sends components or if the laboratory makes the order
Implantology - information on the implant(s)

Photographic protocol:
- colour scale
- standing, facing with relaxed smile
- standing, facing with spontaneous smile
- standing in profile

Sending protocol:
- Sending STL(s): upper, lower, articulation
- if available, send provisional STL

Attach files:

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