Provider Uploads

Please complete the form below to submit your patient’s prescription information, files and/or scans. Please be sure to hit Submit once you are finished.

Secure Digital Upload

Doctor's Name *

First

Last *

Last

Patient's Name *

First

Last *

Last

Date Needed *

Profile

Maximum upload size: 62.92MB

Frontal Rest

Maximum upload size: 62.92MB

Frontal Smile

Maximum upload size: 62.92MB

Maxillary Occlusal

Maximum upload size: 62.92MB

Drag and drop individual photos from desktop folder to respective tiles.

Mandibular Occlusal

Maximum upload size: 62.92MB

Right Buccal

Maximum upload size: 62.92MB

Frontal

Maximum upload size: 62.92MB

Left Buccal

Maximum upload size: 62.92MB

X-Ray

Maximum upload size: 62.92MB

Digital Scan or Impression Model

Digital Intraoral Scan (.stl)

PVS Impressions or Models

Digital Intraoral Scan (.stl)

Maximum upload size: 62.92MB

PVS Impressions or Models

We'll be sending you an impression kit including a box with a return label. Please include a bite registration with the impression or models.

Click Here to Complete Our Prescription Form*

Please add any additional information

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