LABORATORY ALIGNERS LABORATORY ORDER FORM Please enable JavaScript in your browser to complete this form.Delivery Location (Practice) *Clinician Name *Patient Full Name *Scan date *The Laboratory will use this scan for the appliance(s) below: – Please be sure this is filled out!Due Date *(3 working days minimum, 7 for In-house Aligners)Lab services:Retainers Retainer for Life (3x Retainer Sets) Retainers with minor correction (per arch)Whitening Trays (per arch)Study Models (per arch)MouthguardsSplint 3D printedMilled Splint (new)Lingual Wire3D Virtual Interdisciplinary Smile Simulation (Individual) – For veneers, bonding etc. 3D Virtual Interdisciplinary Smile Simulation (Multiple) – For veneers, bonding etc. VISS StentCrownVeneerPontic RetainerAesthetik Aligners – SIMULATION (For patient approval)Upper/Lower/SetUpper and LowerUpper OnlyLower Only Laboratory/Other treatment notes:Signature *Clear Signature Title of the document Privacy Policy Terms & Conditions