ALIGNER REPLACEMENT

Your Email *

Doctor's Name *

subject *

Patient's First Name *

Patient's Last Name *

Which step would you like us to replace & how many from each step? (Please mention if its upper, lower or both) *

Reason for Replacement *

Broken Aligner / Retainer

Lost Aligner / Retainer

Teeth Tracking Issues

Other

*

Remark: *

Each aligner replacement (one arch) costs $20.

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ALIGNER REPLACEMENT​​