Bracket Setup Doctors

SUBMIT NEW BRACKETS & WIRE

Doctor's Name

Doctor's Office

Contact Email

Attach Invoice Including Part Numbers

(Optional) Additional Invoices

__________________________________________________

Are The Finishing Wire Part Numbers Included In the Invoice?
YesNo

1. Finishing Wire Manufacturer + Form

2. Finishing Wire Manufacturer + Form

3. Finishing Wire Manufacturer + Form

__________________________________________________

Will The Doctor Be Using Inverted Brackets?
YesNo

Invert Definition: The rotation of a bracket on a tooth by 180 degrees.
Please Note: No additional brackets need to be sent for this.

Which Brackets Will Be Inverted?

Set 1

Set 2

Set 3

__________________________________________________

Please check your email for information about shipping brackets and finising wires to DIBS AI.

Contact Support:
801-763-5039
support@dibsai.com

*Please fill in personal information