Clinical Prescription 

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Confirm Schedule:

Treat Arches

Bridges, ankylosed, teeth or implants not to be moved

R

L

Crowns, Labial or buccal restorations

R

L

Midline Change:

Recommended limit <2mm

Crowding Resolution

Upper

Procline:

Expand:

Anterior IPR:

Posterior IPR right:

Posterior IPR left:

Lower

Procline:

Expand:

Anterior IPR :

Posterior IPR right:

Posterior IPR left:

Spacing resoluton

Upper

Lower

Anterior -Posterior (A-P) Relationship
Docter Prefrences

Smile Simulation

Clear Aligner Material Thickness
Stages per Delivery
Attachments

*Please submit files via WeTransfer (www.wetransfer.com) and email to production@medicore.co.za
Use patient name as your reference

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