Submit a case.

Upload your prescription and scan files, or let us know you're shipping a mold. William will follow up to confirm details.

Important: Do not include patient names, dates of birth, or any patient-identifying information in this form. We'll collect case-specific details by phone or email.

Your internal case or chart ID — do not enter patient names
Office is shipping a physical mold or impression
Case notes from submitter — must NEVER contain patient names or identifiers
Upload your completed lab Rx form (PDF, image, or scan)
Upload digital scan files or intraoral photos (select multiple)