Online order form

Contact Name *
Contact Name
Order reference should not include patient's name in order to ensure patients privacy. Please use reference code with numbers and texts instead of the name.
Please indicate the tooth notation number of each abutment & bridge unit.
Screw Channel *
Implant Lab Analogue *
Fitting is guaranteed only with ARUM Analogue and Original Analogue, please specify which Analogue you have used for this case.
Implant Type *
Materials - 1 *
Materials - 1
Materials - 2 (optional)
For Titanium Custom Abutment
Confirmation *