Schedule a Pickup

We'll pick up your cases from your practice. Free prepaid shipping label included.

Practice Information

Dentist Name*

Practice Name*

Email*

Phone*

Pickup Address

Street*

City*

State*

Zip*

Preferred Pickup Date

Date*

Time Window

Case Information

Case Types *

Number of Units

Opposing models included

Special Instructions (optional)

Add Mail-In Kit (+45.00) — impression material, sleds & shipping box

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