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Lab work request - Active Aligners UK
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* Indicates required question
Email
*
Your email
Doctors Name
*
Your answer
Practice Name
*
Your answer
Patients Name
*
Your answer
Product
*
Replacement Aligner/s
Replacement Retainer/s
Template/s
Other - please specify
Required
Material
*
Choose
Clear
Extra Tough Opaque (only available for retainers with Express & Express plus orders)
Service Required
*
Choose
Standard - Turnaround time of 14 working days (£20 per aligner/template and £25 per retainer)
Express - Turnaround time of 7 working days (£40 per aligner/template and £45 per retainer)
Express Plus - Turnaround time of 3 working days (£60 per aligner/template and £65 per retainer)
Order ID (found on 3Shape)
*
Your answer
Special Instructions and comments (Please send any related files/photos to info@activealigners.co.uk )
*
Your answer
Please send any related files or scans to
info@activealigners.co.uk
Confirmation of order & i
nstructions to LAB
This Lab order form instructs the lab to continue with the manufacture of the product request selected.
*
I have read and accept the above "Confirmation of Instructions to LAB". By checking this box I confirm the product selected and instructions included in this form are correct.
Required
A copy of your responses will be emailed to the address you provided.
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