UPLOAD CBCT SCANS - This form is Secure and HIPAA Compliant

Surgical Specialist
Name: *
Patient Name: *
Restorative Dentist
Name: *
Files uploaded by: *

Please Note: model work is required for successful surgical planning.

Materials sent to lab by: *Surgical Specialist:
Restorative Dentist:
Select Arch or Tooth Numbers: *
Desired Final Prosthesis: *
Instructions: *