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Company Name*
Contact First Name*
Contact Last Name*
Email Address*
Patient First Name*
Patient Last Name*
Tooth Number*
Please indicate the tooth notation number of each abutment & bridge unit.
Screw Channel*Angulated Screw ChannelStraight Screw ChannelNone
Secondary Screw to be sent for clinician?*Yes (+7.50 GBP)No
Implant System*
Implant Size*
Implant Type*EngagingNon-Engaging
Materials 1*TitaniumCobalt ChromeZirconiaBio HPP & PEEKPMMAComposite
Materials 2 (optional)NoneTitaniumCobalt ChromeZirconiaBio HPP & PEEKPMMAComposite
Shade Colour (optional)
Message (optional)
Please use WeTransfer to send your designs through.
I hereby certify that the above statements are true and correct to the best of my knowledge.
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