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Smart Aligners
Smart Aligners Order Form
Smart Aligners Order Form
Name of the Clinician / Clinic Name *
DCI Number *
Address *
Contact Number *
Mail ID *
Mode of Collection
Direct
Mail
Patient Details
Patient Name *
Age *
Gender *
Female
Male
Patient's Concern *
Clincheck Video Planned
Delivery Planned
Treatment Planned
IPR
Extraction
Distalization
Expansion
Other Specifications
Attachment Options
Yes
No
Aligner Category Planned
Premium
Regular
Enclosed Files
Photos
X-Rays
Intraoral Scans (stl)
Case Upload *
Select up to 15 files at one time. Maximum total upload size is 25 MB.
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