Retainer Order

"*" indicates required fields

Doctor Name*

First Last

Patient Name*

First Last

Select Retainers Desired*

Set of Upper and Lower

Upper Only

Lower Only

Enter Quantity*

Please enter a number from 1 to 10.

Doctor Instructions

Model Type for Retainer Fabrication*

Use Final Step of Last Treatment

Intraoral Scan (STL File)

PVS Impression

Stone Model

Scanner Used*

Trios

iTero

Omnicam

Primescan

Carestream

Heron

Medit

3M

Planmeca

Other

Intraoral Scans

Drop files here or Select files

Accepted file types: stl, dcm, stl, dcm, Max. file size: 1 GB.

Need A Prepaid Shipping Label for Impressions/Models?*

Yes

No

Email Address For Sending Shipping Label*

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Production Priority*

Normal production time is approximately 3-5 business days from the time the retainer order is accepted.

Normal

RUSH ($50 Additional Fee)

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Requested RUSH Delivery Date for Retainers

MMMM123456789101112

DDDD12345678910111213141516171819202122232425262728293031

YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Ship To:*

Office Address

Patient Address

Office Shipping Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Patient Shipping Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Consent to Terms of Use & Service and Privacy Policy*

I accept and agree to the Trez Terms of Use, Terms of Service, and Privacy Policy found in the About section of this website

Yes