Labslip Doctor / Office Information Patient Info / Due Date Normal Rush For 3D Cases Only -- Select (Required) -- **Universal Rx (PREFER)** iTero 3M 3Shape CareStream Easy Rx Prescription ㆍRetainer - Standard Hawley Retainer - Circumferential Hawley Retainer - Hawley with Flat Bow Retainer - Circumferential with Flat Bow Retainer ㆍPressform Appliance - Essix - Bleaching Tray - Soft Night Guard - Sports Guard - EZ Bonding ㆍRemovable Appliance - Schwartz Appliance - Sagittal Appliance 2 Way - Fan Type Removable Expander - Three Way Expander ㆍFixed Appliance - Lingual Holding Arch - Nance - Thumb Habit with Spurs - Tongue Habit - Tongue Habit with Loops - Tongue Bead - Transpalatal Arch - Fixed Anterior Bite Plate - Rickanator/Bite Ramp ㆍSplint - Hard Acrylic Night Guard - Thermoplastic Night Guard - Gelb - NTI - M-MARPE® - Fixed Sagittal ㆍDistalizer Appliance - Lip Bumper - Distal Jet - T-Rex / Pendex - Pendulum ㆍFixed Expander - Bi Helix - Arnold Expander - Porter Expander - Fan Type Expander - Rapid Palatal Expander (Hyrax) - Compact RPE - Bonded RPE - Haas - Quad Helix ㆍFunctional Appliance - Bionator without Screw(open) - Bionator without Screw(close) - Twin Block Without Screw - Herbst Telescopic with TPA and LLHA - MARA with TPA and LLHA DRAWING COLOR CHART ADD COLOR REMOVE COLOR OVERVIEW SELECTED APPLIANCE - - COLOR ADDED - × Pattern Neon Glitter Clear Solid Sport Animal Custom Title : Title : Title : Title : Title : Title : Title : Title : Bands -- Select (Required) -- Please include bands (Additional charge applied per band) Will send bands separately (Case will be pending until bands are received) Not Applicable Instructions Ball Clasp "C" Clasp Adams Clasp Add Pontics Special Requests Case Type STL UPLOAD IMPRESSION / STONE MODEL INSTRUCTION1. Print out lab slip 2. Send Impression Model and lab slip to: 11917 Front St, Norwalk, CA 90650 SUBMIT PRINT New Case
