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Doctor's Info:
*Name:
*Email:
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No
*Bill and ship same address?
*Due date back in your office?
*Where to ship?
Implant Info:
*Implant:
Mandible
Maxilla
*Implant company:
*System:
*Preferred platform size :
Implant Info:
*How many implants are you placing?
1
2
3
4
5
6
7
8
*Pilot guide or Fully guided:
Pilot guide
Fully guided
Yes
No
*Temp crown required?
*How will you be sending us the CT and STL?
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*Shade:
*How will you send us the info:
*Dropbox Download Link:
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