Send a Case

date:

Dentist Name:

Dental Clinic Name:

Email Address:

Phone Number:

Appliance:Removable:
Special TrayWax BiteTry-inRe-setCrCoDenturesValplast

Appliance: Crown & Bridge:
E-MAXZirconiaInlay/Onlay/VeneerImplant/Bar/AttachmentAll 0n xPFM

Shade:

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: …….., Email: ……….)TriosMeditiTeroCerec SironaGoogle drive / Onedrive / DropboxWetransfer

"If you send the file via google drive / One drive / Dropbox/wetransfer, please copy and paste the link below:"

Please insert the link here to send the file:

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