Section 1 of 1 in this document

Express Positioner Rx

The Express Positioner is designed with our most popular features to take the guesswork out of ordering the appliance.

This appliance will be fabricated as standard with the following features:

Mini size, molded with medium Crystal Flex® material-Molded airways
Full set-up (within limits of appliance capability)
Flat occlusal plane
Average hinge-axis
Braces removed if present
Retained space for Bonded Retainer (if present)

This is my first case with TP Orthodontics

Yes

Account No.

Doctor Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code / Zip

Country

Phone Number

Patient Name

Date Shipped to TPO

Date Required

Color

Clear

Pink

Blue

Purple

Green

Rainbow

Clear will be default if no color is marked.

BLOCK OUT BRIDGES, IMPLANTS, LINGUAL RETAINERS AND PRIMARY TEETH

Block Upper Right

Block Upper Left

Block Lower Right

Block Lower Left

Approve Digital Setup

Yes

Special Instructions

This custom-made device is manufactured to satisfy the design characteristics and properties specified by the prescribing doctor for this specific patient, and is intended for the exclusive use of the named patient.