Design Service – Surgical Guides

Step 1 of 2: Submit Online Rx

Welcome to the new Surgical Guide Design Service Rx.

Steps:

Complete the form and click “Submit RX and go to Records Upload.” Your Rx will be sent to GuidedSMILE, and you’ll receive a confirmation email.
Upload your records on the next page. Once uploaded, your case submission is complete.

If you have any questions, please email ct@guidedsmile.com

Name Of Submitting Lab(Required)

Lab Rep Name(Required)

First Last

Lab Rep Email(Required)

Lab Rep Cell Phone(Required)

Patient Last Name(Required)

Desired Return Date(Required)

Tooth Numbers(Required)

Implant Brand(Required)

Guided Kit(Required)

Additional Notes

Order Total

Name On Card(Required)

First Last

Billing Address(Required)

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