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2. Personal Details

First Name* The First Name* field is required.

Last Name* The Last Name* field is required.

Phone Number*

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Tax Number (TIN) *

Please enter your TIN number for Invoice and reimbursement purposes. If you do not want to enter TIN please enter 999999999 Learn more about TIN

This is a mandatory field. Tax Number has to be 18 symbols maximum

3. Shipping Address

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Street Address*

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* By ordering the Impression Kit and Aligner Kit, you agree to the processing of your health information for the purpose of prescribing a proper treatment and manufacture of the relevant product. You must agree to the Privacy Policy before you continue

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1. Contacts

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