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Aorta Lab Form
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Step
1
of 3
Practice:
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Clinician Name
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Patient Name
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Scan Date:
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Due Date:
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Next
Selection:
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Aligner/Laboratory
Digital Services
Prosthodontics
Aligner/Laboratory:
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White-Label Aligners (DIY)
Zendura Retainers
Zendura Retainers for life (3 pack)
Active retainers (corrective retainers)
Pontic Retainer
Whitening Trays
Mouthguards
Splint
Lingual Wire
Retainer options 1:
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Zendura retainer
Restorative retainer (cut short)
Corrective retainer options:
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Active retainers (corrective retainers)
Active: Up to 3 sets of aligners (maximum 5° rotation / 0.5mm movement)
Upper/Lower retainer option:
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Upper and Lower
Upper Only
Lower Only
Upper/Lower retainer for life options:
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Upper and Lower
Upper Only
Lower Only
Upper/Lower restorative (cut short) retainer options:
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Upper and Lower
Upper Only
Lower Only
Active retainer options:
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Upper and Lower
Upper Only
Lower Only
Retainer with pointic options:
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Upper and Lower
Upper Only
Lower Only
Upper/Lower Lingual wire options:
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Upper and Lower
Upper Only
Lower Only
Upper/Lower whitening tray option:
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Upper and Lower
Upper Only
Lower Only
Mouthguard color:
White-label Aligner options:
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Simulation only:
Platinum:
Simulation only: Preliminary simulation – no cost
Platinum: Up to 10 sets of aligners + 1 refinement (20 total)
White-label Aligner options:
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Express:
Active retainers (corrective retainers)
Express: Up to 10 sets of aligners – no refinement
Active: Up to 3 sets of aligners (maximum 5° rotation / 0.5mm movement)
White-label options:
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Upper and Lower
Upper Only
Lower Only
Refinement Platinum #
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N/A – First order
1 (included with Platinum option)
Extra – Additional cost
Refinement #
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N/A – First order
Extra – Additional cost
Splint options 1:
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Milled (Hard)
3D Printed (Soft)
Digital Services:
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Virtual Interdisciplinary Smile Simulation (VISS)
Mentorship (select for options)
Mentorship: AORTA Students only – to register see website or call 0400 480 850*
VISS options 1:
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Restorative Only
Restorative + Ortho
VISS Restorative options:
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Simulation only
Stent Only
Simulation + Stents
VISS Restorative + Ortho options:
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Simulation only
Stent Only
Simulation + Stents
VISS Restorative options:
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Upper and Lower
Upper Only
Lower Only
VISS Restorative + Ortho options:
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Upper and Lower
Upper Only
Lower Only
Mentorship options:
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Ortho/Aligners
Multidisciplinary (Resto)
Practice Growth/Business
AORTA Students only – to register see website or call 0400 480 850*
Prosthodontics
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Veneers
Crowns
Bridge
Pontic Retainer
Prosthodontic notes:
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Additional notes:
UPLOAD STL FILES (If you have not connected your scanner to our lab please contact us to assist)
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You can upload up to 4 files.
UPLOAD PHOTOS (If required)
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You can upload up to 4 files.
Title of the document
Privacy Policy
Terms & Conditions
I have read and agree to the above terms and conditions & privacy policy in the links above – The following terms and conditions are in effect as of the date of the receipt of your order, as applicable, and will constitute an agreement between you (“Doctor”) and ("Aorta Australia pty ltd”). By accepting this case you claim to take full responsibility and are directly and solely liable for the patients treatment as the prescribing doctor. The Contractor agrees to indemnify and keep the Practice indemnified from and against any and all Claims, costs, damages or liabilities that may arise as a consequence of the Contractor providing Services to the patient listed within.
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I agree
Prices may vary and be changed at any time without further notice. Prices shown are without GST – ABN: 42 605 087 849 | 11/37-39 Albert Road, Melb, Vic 3004 | lab@aortaaustralia.com.au | 0400 480 850
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