Full Arch Surgical Rx

Practice Address*

Phone*

Email Address*

I am the restorative doctor

I am the surgeon, working with a restorative doctor

Next-day Temporary (Please submit scans from day of surgery by 11am CT)

STL Files for In-office Print in 1.5 Hours (Please submit scans from day of surgery by 2pm CT)

Photogrammetry

Simpli-IOS^Tm (IOS with scanning flags)

Implant System*

Total Implant Sites*

Implant Platform Sizes*

MUA’s Brand*

Request for Design Approval?

Are you a member of a Group Practice Organization or DSO?*

Yes

No

Dental Service Organization*

Solve Puzzle: 72 - 27 *

Full Arch Surgical Rx (Digital Workflow ONLY)