Reveal® Aligner Cases: Clinical Preferences

The purpose of this form is to capture your default clinical preferences to be applied to your Reveal Clear Aligner cases. The information captured on this page will allow the treatment planning team to apply your preferences without the need for multiple outreach efforts and enable expediting of your cases and reduce delays. Please complete this form to the best of your abilities and contact your Henry Schein Orthodontics rep for any needed support.

Doctor's Full Name *

Account Number (HSO)

Account Number (JDE or Ship to Number)

Email *

Phone *

Practice Name *

Country *

*

	Correct	Maintain
Curve of Spee Correction:	Correct	Maintain

*

	Correct	Maintain
Curve of Wilson Correction:	Correct	Maintain

*

	No Contact	Light	Heavy
Anterior Occlusal Contacts:	No Contact	Light	Heavy

*

	Light	Heavy
Posterior Occlusal Contacts:	Light	Heavy

*

	Always Correct	Upon Request
Class I Molar:	Always Correct	Upon Request

*

	Always Correct	Upon Request
Class I Cuspid:	Always Correct	Upon Request

*

	Only on the Bicuspid Area	Molar to Molar
Posterior Expansion:	Only on the Bicuspid Area	Molar to Molar

*

	Wide	Normal	Narrow
Arch Form:	Wide	Normal	Narrow

*

	Use as needed	Never use
Anterior Bite Ramps:	Use as needed	Never use

*

	No IPR	0.2 IPR Max	Lab Suggest
IPR:	No IPR	0.2 IPR Max	Lab Suggest

*

	No Attachments	Minimal use	Lab Suggest
Attachments:	No Attachments	Minimal use	Lab Suggest

*

	Hooks on the Maxillary 3’s and Cut Off on Mandibular 6’s	Do not add any elastics
Class II Correction:	Hooks on the Maxillary 3’s and Cut Off on Mandibular 6’s	Do not add any elastics

*

	Hooks on the Mandibular 3’s and Cut Off on Maxillary 6’s	Do not add any elastics
Class III Correction:	Hooks on the Mandibular 3’s and Cut Off on Maxillary 6’s	Do not add any elastics

*

	Always correct	Only upon request
Midline:	Always correct	Only upon request

*

	Always correct	Only upon request
Overjet:	Always correct	Only upon request

*

	Always correct	Only upon request
Overbite:	Always correct	Only upon request

*

	Always correct crown tipping to optimize root parallelism	Only upon request
Roth Parallel Positioning:	Always correct crown tipping to optimize root parallelism	Only upon request

ADDITIONAL NOTES FOR LAB TECHNICIANS: