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  • Clear Aligner Laboratory Form v1.pdfPatients name: Date of Birth: Gender: M F Case type: Full Limited Retainer Only Doctors name: Practice name: Practice address: Address Tele Post
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Patients name: Date of Birth: Gender: M F Case type: Full Limited Retainer Only Doctors name: Practice name: Practice address: Address Tele Post Code Email: shifted right mm Canine relationship right: class left: class Requirements Chief Complaint shifted left mm Lower midline shifted right mm shifted left mm Upper midline Molar relationship right: class left: class LABORATORY FORM If you leave any of these options blank, we'll perform the default action highlighted in green. Treat arches Upper midline Lower midline Overjet Overbite Procline Expand Distalise IPR Close all spaces Other instructions upper lower maintain improve maintain improve maintain improve maintain improve maintain improve maintain improve maintain improve maintain Do not move these teeth (bridges, ankylosed teeth, etc.) R L Avoid engagers on these teeth (facial restorations, etc.) R L I want to extract these teeth R L INSTRUCTIONS 8 7 6 5 4 3 2 1 Submission of this lab form cconstitutes an official order CA V1 2016/1 International Clear Aligner Arch Form Canine Relationship Molar Relationship Posterior Crossbite improve Overjet Overbite BASIC INFORNATION 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 Yes No Only if needed Yes No Only if needed Yes No Only if needed Yes No Only if needed Yes No Only if needed Please email us for more support [email protected] CA Laboratories Ltd, Unit 11 Westmaynes Industrial Park, Bramston Way, Basildon Essex SS15 6TP Centered Centered Digital Treatment Assessment Plan Required

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  • Patients name:

    Date of Birth:

    Gender: M F

    Case type: Full Limited Retainer Only

    Doctors name: Practice name: Practice address: Address

    TelePost Code

    Email:

    shifted right mm

    Canine relationship right: class

    left: class

    Requirements Chief Complaint

    shifted left mm

    Lower midline

    shifted right mm

    shifted left mm

    Upper midline

    Molar relationship right: class

    left: class

    LABORATORY FORM

    If you leave any of these options blank, we'll perform the default action highlighted in green.

    Treat arches

    Upper midline Lower midline

    Over jet Overbite

    Procline

    Expand

    Distalise

    IPR

    Close all spaces

    Other instructions

    upper lower

    maintain improve maintain improve maintain improve

    maintain improve

    maintain improve maintain improve maintain improve

    maintain

    Do not move these teeth (bridges, ankylosed teeth, etc.)

    R L

    Avoid engagers on these teeth (facial restorations,etc.)

    R L

    I want to extract these teeth

    R L

    INSTRUCTIONS

    8 7 6 5 4 3 2 1

    Submission of this lab form c constitutes an official order CA V1 2016/1

    In t e r n a t i o n a lClear Aligner

    Arch Form Canine Relationship

    Molar Relationship

    Posterior Crossbite

    improve Over jet Overbite

    BASIC INFORNATION

    8 7 6 5 4 3 2 1

    1 2 3 4 5 6 7 8

    1 2 3 4 5 6 7 8

    8 7 6 5 4 3 2 1

    8 7 6 5 4 3 2 1

    1 2 3 4 5 6 7 8

    1 2 3 4 5 6 7 8

    8 7 6 5 4 3 2 1

    8 7 6 5 4 3 2 1

    1 2 3 4 5 6 7 8

    1 2 3 4 5 6 7 8

    Yes No Only if needed

    Yes No Only if needed

    Yes No Only if needed

    Yes No Only if needed

    Yes No Only if needed

    Please email us for more support [email protected]

    CA Laboratories Ltd, Unit 11 Westmaynes Industrial Park, Bramston Way, Basildon Essex SS15 6TP

    Centered Centered

    Digital Treatment Assessment Plan Required

    Doctors name: Patients name: Practice name: Date of Birth: Requirements 1: Requirements 2: nt: class: class_2: class_3: 1: 2: 3: undefined: Group3: 0class_5: class_6: class_7: class_4: class_8: Check Box5: OffCheck Box6: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffCheck Box23: OffCheck Box24: OffCheck Box25: OffCheck Box26: OffCheck Box27: OffCheck Box28: OffCheck Box29: OffCheck Box30: OffCheck Box31: OffCheck Box32: OffCheck Box33: OffCheck Box34: OffCheck Box35: OffCheck Box36: OffCheck Box37: OffCheck Box39: OffCheck Box40: OffCheck Box41: OffCheck Box42: OffCheck Box38: OffCheck Box43: OffCheck Box44: OffCheck Box45: OffCheck Box46: OffCheck Box47: OffCheck Box48: OffCheck Box49: OffCheck Box50: OffCheck Box66: OffCheck Box59: OffCheck Box60: OffCheck Box61: OffCheck Box62: OffCheck Box63: OffCheck Box64: OffCheck Box65: OffCheck Box51: OffCheck Box67: OffCheck Box52: OffCheck Box68: OffCheck Box53: OffCheck Box69: OffCheck Box54: OffCheck Box70: OffCheck Box55: OffCheck Box71: OffCheck Box56: OffCheck Box72: OffCheck Box57: OffCheck Box73: OffCheck Box58: OffCheck Box74: OffCheck Box75: OffCheck Box76: OffCheck Box77: OffCheck Box78: OffCheck Box79: OffCheck Box80: OffCheck Box81: OffCheck Box82: OffCheck Box83: OffCheck Box84: OffCheck Box85: OffCheck Box86: OffCheck Box87: OffCheck Box88: OffCheck Box89: OffCheck Box90: OffCheck Box91: OffCheck Box92: OffCheck Box93: OffCheck Box94: OffCheck Box95: OffCheck Box96: OffCheck Box97: OffCheck Box98: OffCheck Box99: OffCheck Box100: OffCheck Box101: OffCheck Box102: OffCheck Box103: OffCheck Box104: OffCheck Box105: OffCheck Box106: OffCheck Box107: OffCheck Box108: OffCheck Box109: OffCheck Box110: OffCheck Box111: OffCheck Box112: OffCheck Box113: OffCheck Box114: OffCheck Box115: OffCheck Box116: OffCheck Box117: OffCheck Box118: OffCheck Box119: OffCheck Box120: OffCheck Box121: OffCheck Box123: OffCheck Box124: OffCheck Box125: OffCheck Box126: OffCheck Box127: OffCheck Box128: OffCheck Box129: OffCheck Box130: OffCheck Box131: OffCheck Box132: OffCheck Box133: OffCheck Box134: OffCheck Box135: OffCheck Box136: OffCheck Box137: OffCheck Box138: OffCheck Box150: OffCheck Box151: OffPractice address: post code: address line: email:


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