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Upper Retainer

Upper Retainer

SKU:

$39.00

Unavailable

per item

Translucent upper retainer designed with comfortable rounded edges.

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PATIENT NAME (please give us the name of the person who will be wearing the retainer) *

Do you require an artificial tooth in your retainer? Select all that apply 1 (+ $30.00) 2 (+ $60.00) 3 (+ $90.00) 4 (+ $120.00) 5 (+ $150.00) 6 (+ $180.00)

What is the date of birth of the person wearing the retainer?

When last did you wear your retainer? Select all that apply Under 1 week ago Under 2 weeks ago Its been more than 2 weeks

What is the name of your orthodontist? *

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Upper Retainer

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