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Patient Intake Form new common

Aligner Type

Basic Details

Doctor Name

Clinic Name

Whatsapp Number

Email Address

3D MODEL PRINTING QUALITY

0.1 mm (IDEAL RECOMMENDED)

0.075 mm

0.050 mm

treatment

Ideal Aligner Protocol

Customized Aligner Protocols

Torque

Tip

Buccal –lingual

Mesial distal

Intrusion extrusion

Rotation

Radio Field

Single Stage

Multi Stage

Additional comment

Attachment comment

Patient details

Patient Name

Patient Age

Patient Chief Complaint

Chief complaint

Proclination

Spacing

Crowding

Crossbite

Upper Arch ( Upload .stl File )

Choose File

Lower Arch ( Upload .stl File )

Choose File

Intraoral Pics

Choose File

Molar relation

Class 1

Class 2

Class 3

Overjet (mm)

High / thick Frenum attachment

	Yes	no
Upper
Lower

Teeth Anatomical Variation (If any)

Missing

UPPER

LOWER

Crown Bridge

UPPER

LOWER

Spacing:

Up to 2mm

2-4mm

More than 4mm

None

Crowding:

Up to 2mm

2-4mm

More than 4mm

None

Rotation

0° – 16°

17° – 45°

More than 45°

Proclination

Absent

Present

Overjet

Absent

Present

Extra comments if needed :

Submit Your Case Records

Courier a Model

Mail IT

WhatsApp IT

Upload Files

Option to upload stl file

Option to upload patient intra oral pictures

Upper

Choose File

Lower

Choose File

Front view

Choose File

Right side ( occlusion )

Choose File

Left (occlusion)

Choose File

TREATMENT PLAN PROTOCOLS

treatment

Ideal Aligner Protocol

Customized Aligner Protocols

Torque

Tip

Buccal –lingual

Mesial distal

Intrusion extrusion

Rotation

Radio Field

Single Stage

Multi Stage

Additional comment

Attachment comment

3D MODEL PRINTING QUALITY

0.1 mm (IDEAL RECOMMENDED)

0.075 mm

0.050 mm

Aligner Sheet Selection

Radio Field

Single Layer

Multi Layer

Select Single Layer

ERKODUR

DURAN+

ERKODUR AL

select Multi Layer

ZENDURA

SCHUE DENTAL ALIGNER PRO

CUSTOMISED BRANDING

Select one

Upload clinic logo/design

Standard Design

Upload Your Clinic Logo/Design

Choose File

Additional Comments

ANTERIOR OPENBITE CORRECTION WITH ALIGNRES- IDEAL ALIGNER SOLUTION

INTRODUCTION TO IDEAL ALIGNER SOLUTIONS

Solutions

Quick Link

Contact Info

Patient details

Missing

Crown Bridge

Submit Your Case Records

Option to upload stl file

Option to upload patient intra oral pictures

TREATMENT PLAN PROTOCOLS

Aligner Sheet Selection

CUSTOMISED BRANDING