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Orthodontics / Aligners / Aligner Digital Design: CLINICAL ALIGNER PLAN

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ORDER INFORMATION

Patient Name or Identifier*

Treatment Name*

Interested in Including a Midcourse Refinement

Interested in a Fix Lingual Retainer *

Send me a FREE Remote Monitoring Scope - $24 Value. (iSmileMonitoring.com)? *

How Many Aligners Should Be Included In Each Shipment (up to two years)? *

Has Patient Previously Had Any Orthodontic Treatment? *

Clinical Case Review

Create Button Transfer Tray *

Aligner Frequency *

Duration

Chief Complaint

Anterior Movement Only or Full Arch Adjustment *

How will Opposing Arch Be Corrected *

Previous Patient Aligner Treatment Experience

Additional information for Lab

Visit BlueSkyAligners.com/Mentoring for more information.
This service includes
*2D Smile Design Simulation
*Clinical Digital Tooth Setup
*Viewer
*Manufacturing of ALL Aligners
*Remote Patient Monitoring
*Movement Analyzer
*Clinical Mentoring

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Total Order :

$ 1895.00

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Card Holder Name

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Expiry Year is Required.

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Aligners

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