Nobel Same Day Design Patient Info and Records

Use the form below to submit all necessary Patient Info and Records for your Same Day Design Case. Upon submission, you will receive an email notification for your records, and GuidedSMILE will begin on your case.

If you have any questions, please email care@guidedsmile.com, or call us at 800-763-7821.

Doctor Name(Required)

First Last

Doctor Email(Required)

Doctor Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Patient Name(Required)

First Last

Have you pre-booked design services?(Required)

Yes, I have pre-booked services

No, I have NOT pre-booked resources. I will call GuidedSMILE (1-800-763-7821) to confirm available resources.

In order to guarantee a 1-hour turnaround time you need to have pre-scheduled planning resources 48 hours in advance. If you have not done so call us 800-763-7821 to confirm available resources.

Which Grammetry / Photogrammetry Option?(Required)

Grammetry Records(Required)

Other

Who is fabricating the prosthesis?(Required)

Email to send STL files(Required)

What type of prosthetic design?(Required)

Tooth Shade(Required)

Tissue Shade(Required)

Arch(Required)

Screw Brand(Required)

Include Screws?(Required)

Do you need a driver?(Required)

Healing Collar Brand(Required)

Other

How are you submitting your files?(Required)

IOS Portal(Required)

Name of other IOS

Other Case Records

File

Drop files here or

Accepted file types: zip, stl, png, ply, pdf, img, doc, , Max. file size: 256 MB.

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Nobel Same Day Design Patient Info and Records