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Clear Aligner Prescription Form
Clear Aligner Prescription Form
Clear Aligner Prescription Form
Prescribing Doctor Name:
Patient Name:
Treatment required:
Upper and Lower
Upper
Lower
Patient's main concern:
Treatment Goals:
Restorative Tx Plan:
Teeth to avoid moving (Upper and Lower Arch):
Teeth to avoid placing ForceDrivers (Upper and Lower Arch):
How would you like to deal with spaces?
Close them all
Leave specific spaces for restorations
Show me ideal result
How would you like to deal with crowding?
Anterior Alignment Preference:
Alignment to Gingival margins
Alignment to Incisal edges
Upper centrals longer than laterals
Upper centrals and laterals at same level
Proclination
Expansion
IPR
Show me ideal solution
Submit
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