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Night Guard Order Form
Full Name
*
Phone
*
Email
*
How will you be sending your impression
*
How will you be sending your impression
I have a 3D scan file, uploaded or sent directly to
[email protected]
I just purchased an impression kit and will mail-in directly
I don't have a scan and I need guidance (fill out this form and our team will contact you)
Lab Mailing Address:
2771 El Camino Real
Santa Clara, CA 95051
Upload your Scans (if available)
Click to choose a file or drag here
Size limit: 10 MB
Which guard would you like made?
*
Which guard would you like made?
Upper (Most Common)
Lower
Both (medical needs - usually only if doctor recommended)
Not Sure - Lab recommends
Notes
Submit