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About us
Appliances
3d Printing
Work Order
Standard Appliance Work Order
Smile Shapers Work Order
Blog
Contact Us
Smile Shapers
Standard appliance
Smile Shapers
Standard appliance
Standard appliance
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Date Returned (must be 7 or more days out)
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MM slash DD slash YYYY
Select Maxillary Color #1
#cac1aa – 1 Clear
#d37f6f – 2 Clear pink
#c2ae25 – 3 Clear yellow
#eb543d – 4 Clear orange
#c31a00 – 5 Clear red
#17976e – 6 Clear green
#003d82 -7 Clear blue
#41142a – 8 Clear purple
#d3d1c5 – 9 White
#050505 – 10 Black
#ff4402 – 11 Mango orange
#c8640f – 12 Tangerine
#d4aa24 – 13 Lemon yellow
#c12114 – 14 Apple red
#89a166 – 15 Lime green
#6d8f9f – 16 Blueberry
#ff775c – 17 Neon orange
#cbbc95 – 18 Neon glow
#ff5e5a – 19 Neon red
#ff6573 – 20 Neon pink
#e6ae00 – 21 Glow yellow
#e24e52 – 22 Glow pink
#e99759 – 23 Glow orange
#60825b – 24 Glow green
#71788d – 25 Glow blue
#7c5593 – 26 Purple sunset
#f92f25 -27 Lava red
#ff2a44 – 28 Paradise pink
#00a52a – 29 Key lime green
#005297 – 30 Ocean blue
#c5dd34 – 31 Banana yellow
#1c948c -32 Tidewater teal
#f18e9e – 33 Pastel pink
#df4755 -34 Pastel red
#f2c831 – 35 Pastel yellow
#e58f58 – 36 Pastel orange
#7c90c1 – 37 Pastel blue
#6d9b7e – 38 Pastel green
#8f617c – 39 Pastel purple
#b7b7bb – Silver gltr
#8e5f14 – Gold gltr
#1a6151 – Aqua gltr
#004d7b – el Blue gltr
#0a301f – Green gltr
#a81e18 – Red gltr
#040404 – Black gltr
#240e2c – Purple gltr
#8a1409 – Apricot gltr
#6a0b19 – Fuchsia gltr
Would you like a 2nd Maxillary Color?
No
Yes
Select Maxillary Color #2
#cac1aa – 1 Clear
#d37f6f – 2 Clear pink
#c2ae25 – 3 Clear yellow
#eb543d – 4 Clear orange
#c31a00 – 5 Clear red
#17976e – 6 Clear green
#003d82 -7 Clear blue
#41142a – 8 Clear purple
#d3d1c5 – 9 White
#050505 – 10 Black
#ff4402 – 11 Mango orange
#c8640f – 12 Tangerine
#d4aa24 – 13 Lemon yellow
#c12114 – 14 Apple red
#89a166 – 15 Lime green
#6d8f9f – 16 Blueberry
#ff775c – 17 Neon orange
#cbbc95 – 18 Neon glow
#ff5e5a – 19 Neon red
#ff6573 – 20 Neon pink
#e6ae00 – 21 Glow yellow
#e24e52 – 22 Glow pink
#e99759 – 23 Glow orange
#60825b – 24 Glow green
#71788d – 25 Glow blue
#7c5593 – 26 Purple sunset
#f92f25 -27 Lava red
#ff2a44 – 28 Paradise pink
#00a52a – 29 Key lime green
#005297 – 30 Ocean blue
#c5dd34 – 31 Banana yellow
#1c948c -32 Tidewater teal
#f18e9e – 33 Pastel pink
#df4755 -34 Pastel red
#f2c831 – 35 Pastel yellow
#e58f58 – 36 Pastel orange
#7c90c1 – 37 Pastel blue
#6d9b7e – 38 Pastel green
#8f617c – 39 Pastel purple
#b7b7bb – Silver gltr
#8e5f14 – Gold gltr
#1a6151 – Aqua gltr
#004d7b – el Blue gltr
#0a301f – Green gltr
#a81e18 – Red gltr
#040404 – Black gltr
#240e2c – Purple gltr
#8a1409 – Apricot gltr
#6a0b19 – Fuchsia gltr
Select Mandibular Color #1
#cac1aa – 1 Clear
#d37f6f – 2 Clear pink
#c2ae25 – 3 Clear yellow
#eb543d – 4 Clear orange
#c31a00 – 5 Clear red
#17976e – 6 Clear green
#003d82 -7 Clear blue
#41142a – 8 Clear purple
#d3d1c5 – 9 White
#050505 – 10 Black
#ff4402 – 11 Mango orange
#c8640f – 12 Tangerine
#d4aa24 – 13 Lemon yellow
#c12114 – 14 Apple red
#89a166 – 15 Lime green
#6d8f9f – 16 Blueberry
#ff775c – 17 Neon orange
#cbbc95 – 18 Neon glow
#ff5e5a – 19 Neon red
#ff6573 – 20 Neon pink
#e6ae00 – 21 Glow yellow
#e24e52 – 22 Glow pink
#e99759 – 23 Glow orange
#60825b – 24 Glow green
#71788d – 25 Glow blue
#7c5593 – 26 Purple sunset
#f92f25 -27 Lava red
#ff2a44 – 28 Paradise pink
#00a52a – 29 Key lime green
#005297 – 30 Ocean blue
#c5dd34 – 31 Banana yellow
#1c948c -32 Tidewater teal
#f18e9e – 33 Pastel pink
#df4755 -34 Pastel red
#f2c831 – 35 Pastel yellow
#e58f58 – 36 Pastel orange
#7c90c1 – 37 Pastel blue
#6d9b7e – 38 Pastel green
#8f617c – 39 Pastel purple
#b7b7bb – Silver gltr
#8e5f14 – Gold gltr
#1a6151 – Aqua gltr
#004d7b – el Blue gltr
#0a301f – Green gltr
#a81e18 – Red gltr
#040404 – Black gltr
#240e2c – Purple gltr
#8a1409 – Apricot gltr
#6a0b19 – Fuchsia gltr
Would you like a 2nd Mandibular Color?
No
Yes
Select Mandibular Color #2
#cac1aa – 1 Clear
#d37f6f – 2 Clear pink
#c2ae25 – 3 Clear yellow
#eb543d – 4 Clear orange
#c31a00 – 5 Clear red
#17976e – 6 Clear green
#003d82 -7 Clear blue
#41142a – 8 Clear purple
#d3d1c5 – 9 White
#050505 – 10 Black
#ff4402 – 11 Mango orange
#c8640f – 12 Tangerine
#d4aa24 – 13 Lemon yellow
#c12114 – 14 Apple red
#89a166 – 15 Lime green
#6d8f9f – 16 Blueberry
#ff775c – 17 Neon orange
#cbbc95 – 18 Neon glow
#ff5e5a – 19 Neon red
#ff6573 – 20 Neon pink
#e6ae00 – 21 Glow yellow
#e24e52 – 22 Glow pink
#e99759 – 23 Glow orange
#60825b – 24 Glow green
#71788d – 25 Glow blue
#7c5593 – 26 Purple sunset
#f92f25 -27 Lava red
#ff2a44 – 28 Paradise pink
#00a52a – 29 Key lime green
#005297 – 30 Ocean blue
#c5dd34 – 31 Banana yellow
#1c948c -32 Tidewater teal
#f18e9e – 33 Pastel pink
#df4755 -34 Pastel red
#f2c831 – 35 Pastel yellow
#e58f58 – 36 Pastel orange
#7c90c1 – 37 Pastel blue
#6d9b7e – 38 Pastel green
#8f617c – 39 Pastel purple
#b7b7bb – Silver gltr
#8e5f14 – Gold gltr
#1a6151 – Aqua gltr
#004d7b – el Blue gltr
#0a301f – Green gltr
#a81e18 – Red gltr
#040404 – Black gltr
#240e2c – Purple gltr
#8a1409 – Apricot gltr
#6a0b19 – Fuchsia gltr
Upload File
Max. file size: 256 MB.
Submit your .stl file only
Appliance Instructions / Special Requests
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CAPTCHA
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This field is for validation purposes and should be left unchanged.
Smile Shapers
Smile Shapers RX Form
"
*
" indicates required fields
Step
1
of
4
25%
Username
*
Email
*
Password
*
Enter Password
Confirm Password
General Information
Doctor’s Name:
*
Contact Number
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Patient’s Name
*
Gender
*
Male
Female
Date of Birth
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
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25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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2003
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1997
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Patient’s Chief Complaint
*
Canine Class Relationship
Right
Left
Molar Class Relationship
Right
Left
Upper Midline
Centered
Shifted Right
Shifted Right
MM
Shifted Left
Shifted Left
MM
Lower Midline
Centered
Shifted Right
Shifted Right
MM
Shifted Left
Shifted Left
MM
Instructions
Do not move these teeth
Instructions
*
New Order/Case
Refinement Case
R
1
2
3
4
5
6
7
8
25
26
27
28
29
30
31
32
L
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
If Refinement, original case #
Original length of treatment steps
Treat Arches
Upper
Lower
Avoid engagers on these teeth
Instructions #1
Upper Midline
Maintain
Improve
Idealize
Lower Midline
Lower Maintain
Lower Improve
Lower Idealize
Overjet
Overjet Maintain
Overjet Improve
Overjet Idealize
Overbite
Overbite Maintain
Overbite Improve
Overbite Idealize
Canine Relationship
Canine Maintain
Canine Improve
Canine Idealize
Molar Relationship
Molar Maintain
Molar Improve
Molar Idealize
Posterior Crossbite
Posterior Maintain
Posterior Improve
Posterior Idealize
R
1
2
3
4
5
6
7
8
25
26
27
28
29
30
31
32
L
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
I will extract these teeth before treatment
Instructions #2
IPR
Yes
No
If Needed
Engagers
Engagers Yes
Engagers No
Engagers If Needed
Procline
Procline Yes
Procline No
Procline If Needed
Expand
Expand Yes
Expand No
Expand If Needed
Distalize
Distalize Yes
Distalize No
Distalize If Needed
R
1
2
3
4
5
6
7
8
25
26
27
28
29
30
31
32
L
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Leave these spaces open
Retainers
(Smile Shapers recommends waiting for the treatment plan to be completed to fabricate the final retainers)
Leave these spaces open
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Include Final Retainer
Upper
Lower
Include 3 Pack Retainer & Extended Care Package
Upload File
Accepted file types: stl, jpg, gif, png, pdf, Max. file size: 256 MB.
Special Instructions
Special Instructions
*
License No.
*
Signature
