AoX Same Day Case Design Upload

AoX Same Day Case Design Upload
Doctor*
Phone Number*
Area Code & Phone Number
Email*

Confirmation Emailexample@example.com
Practice Branch*
Please include location
Patient Identification Code (PIC)*
Patient Identification Code (PIC) is Required for case communication to maintain HIPAA compliance. Please enter existing PIC (already used within your office). Or Create a 5-7 digit code (alpha & numerical) Example: Pt. John Doe = D13578
Patient Name
Submitting*

Preoperative RecordsSurgery Day Records
Attention, below note for guided cases only:

If there is a surgery/appointment date scheduled, please include it here. Please note, we guarantee shipment of a Synergy case 10 business days after review and approval (allow 2 additional business days for shipping). We do not suggest scheduling a surgery date until you have approved the case.
Surgery Date

Not ScheduledOther
Printing*

In-office printingPrint-and-ship from lab
Working Arch*

UpperLowerBoth
Upper Prosthetic*

FP1FP2FP3
Lower Prosthetic*

FP1FP2FP3
Photographs - Retracted | High Smile | Low Smile | Profile*

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Shade*
Scanner*

Using a handheld IO scannerUsing a photogrammetry scanner
IO Scanner*

Itero [Lumina Only]DexisSirona [Primescan Only]Trios [4/5/6 Only]MeditSHINING3dOther
Photogrammetry Scanner*

AoralscanPICICAMMicronMapperTupel 3d (Grammee)Other
Note - we can only accept scans completed with the OEM scan flags verified for your scanner.
Scan Body*
Screw*
Screw_hidden*
Same-Day Scans:
Initial scan STL(s)*

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Scanbody Scan STL(s)*

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Preoperative Records:
Upper Scan STL(s)*

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Lower Scan STL(s)*

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Bite Scan STL(s)*

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Notes
Should be Empty: