New Case | PX3 Portal

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Doctor Name *

Patient Name *

Billing Email *

Patient Gender

Male

Female

Other

Lower Jaw Scan *

Must submit STL files only*

Upper Jaw Scan *

Must submit STL files only*

CR Bite Scan 1

Must submit STL files only*

CR Bite Scan 2

Must submit STL files only*

Lab Services *

PX3 Design and Print (Standard Shipping)

PX3 CAD Design (Digital Files Only)

Waiver signed *

Special Instructions

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