Retainer Order "*" indicates required fields Doctor Name* First Last Patient Name* First Last Select Retainers Desired* Set of Upper and Lower Upper Only Lower Only Enter Quantity*Please enter a number from 1 to 10.Doctor InstructionsModel Type for Retainer Fabrication* Use Final Step of Last Treatment Intraoral Scans (STL Files) PVS Impressions Stone Models Scanner Used* Trios iTero Omnicam Primescan Carestream Heron Medit 3M Planmeca Other Intraoral Scans Drop files here or Select files Accepted file types: stl, dcm, stl, dcm, Max. file size: 1 GB. Need a Prepaid Shipping Label for Impressions/Models?* Yes No Email Address for Sending Shipping Label* Production Priority*Normal production time is approximately 3-5 business days from the time the retainer order is accepted. Normal RUSH ($50 Additional Fee) Requested RUSH Delivery Date for RetainersMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Ship To:* Office Address Patient Address Office Shipping Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Patient Shipping Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent to Terms of Use & Service and Privacy Policy*I accept and agree to the Clear Comfort Terms of Use, Terms of Service, and Privacy Policy found in the About section of this website Yes Δ
