(AT) Align Technologies Brace

Measurement Order Form

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(*) Required Fields

Please fill out the following information to proceed with the brace production.

    * Scan preferred for ALL cases. When scan is poor, proceed to casting. The cast must include the shoulder girdle and be draped, marked with landmarks and scanned. Please send scan of cast.



    X-Ray Analysis


    Cobb Angleº / Side (Select Left or Right)

    Scoliometer Rotationº / Side (Select Left or Right)

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    Clinical Evaluation

     

    Additional Patient Information

     

    Complete Order Checklist

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