From: $165.00

These pre-submission forms ensure accurate treatment prescription and can be branded to your laboratory.

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*Due to the placement of this logo on a dark background, we require a white .eps or .ai file (a .png or .jpeg file are acceptable, but not preferred). A .png with a white background is not acceptable.
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An 8 ½ x 11, 2-part NCR form that prints in 2 colors. Every clinician must submit a pre-submission form prior to prescribing Smile Shapers to their patient. This form allows for accurate treatment prescription and will provide both the clinician and patient with insight into the length and cost of treatment. This form can be branded with your lab’s logo and is available in 250 and 500 quantities. Simply provide all necessary information, including the name and website URL for your laboratory. When uploading your laboratory’s logo, please choose a hi-res version in any of the following, approved formats: .ai, .eps, .pdf, .png, .jpg, or .jpeg. Afterwards, please select quantity and add to cart.

Additional information


250, 500, 1000