Online order form

Contact Name *
Contact Name
Order reference should not include a patient's name in order to ensure patients privacy. Please use reference code with numbers and texts instead of the name.
Please indicate the tooth notation number of each abutment & bridge unit.
Screw Channel *
Implant Lab Analogue *
Fitting is guaranteed only with ARUM Analogue and Original Analogue, please specify which Analogue you have used for this case.
Implant Type *
Materials - 1 *
Materials - 2 (optional)
For Titanium Custom Abutment
Confirmation *