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1. Contacts
Email*
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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*
Digits only
This is a mandatory field. Phone number has to be digits only - 25 symbols maximum
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
Country *
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The Country * field is required.
City*
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Post Code*
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Street Address*
Please enter your street and street number
The Street Address* field is required.
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You must agree to General Terms and Conditions before you continue
I declare that I have read and I agree with the Form of Informed Consent and the
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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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