Design Order Form

Complete the form below to submit your design request.
Fields marked with * are required.

Clinic Information

Clinic / Lab Name *

Doctor / Technician Name *

Email *

Phone / WhatsApp *

Country *

Patient Information

Patient ID / Case Number *

Use an ID or code instead of the patient's real name for privacy.

Age

Gender

Male Female Other

Receipt Date

Requested Delivery Date

Service & Design Details

Service Type *

Complete Denture

$50

All-on-X Monolithic

$150

All-on-X Complex

$200

Additional Options Print & Milling Service Optional selection. Pricing will be confirmed separately after review.

Express Turnaround 24-Hour Express Turnaround (+20%) This premium service ensures your case is prioritized and completed within 24 hours.

Jaw Selection *

Upper Lower

Select Upper, Lower, or both.

Teeth Shade

Occlusion Type

Specific Instructions / Notes

Include any special requests, preferences, or clinical notes here.

Scan Files & Photos — Direct Upload

Upload Your Case Files

Please upload all your scan files (STL, PLY, OBJ, DCM, ZIP, RAR) and patient photos (frontal, profile, intraoral, shade guide). Files are uploaded directly to our secure cloud storage.

Click the file selector below and choose your case files.
You can select multiple files at once (Ctrl/Cmd + click).
Wait for all files to finish uploading before submitting.

Maximum file size: 2 GB per file. No file count limit.

Select Files *

Supported formats: STL, PLY, OBJ, DCM, ZIP, RAR, JPG, PNG, PDF

0 files uploaded

Order Summary & Payment

Order Summary

Selected Service Not selected

Base Price $0

24-Hour Express (+20%) $0

Total $0

Payment Method *

PayPal

Credit / Debit Card

PayPal Payment
After submitting this form, a PayPal payment button will appear.
Payment will be matched with your order using the generated order number.

Credit / Debit Card Payment
After submitting this form, a secure payment button powered by PayPal will appear.
You can pay with Visa, Mastercard, AMEX, or other major cards — no PayPal account required.

Message to Designer

📌 Refund Policy & Limitation of Liability • Once the design work has started, refunds are not available.
• One free revision is included per order. Additional revisions may incur extra fees.
• We are not liable for any clinical outcomes resulting from the use of our designs.
• Please review your order carefully before submission.

I have read and agree to the refund policy and limitation of liability above. *

International Denture Design Order Form

Clinic Information

Patient Information

Service & Design Details

Scan Files & Photos — Direct Upload

Order Summary & Payment

Order Received — Complete Your Payment