Case submission form

Warning: Cases should be submitted online. Only download this form if you've been directed to do so.

If you just want to submit a case, do not use this form. Go to the doctor's portal, and click "Submit a case." More details are available here.

This form is being provided for one reason: if you mistakenly send in impressions without submitting a case online, our staff may create a new case for you. On the case page, you will then see "Waiting for new case form."

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That's the only time you need this form. Download it and fill it out, then return to the case page, click "upload," and upload the scanned form. To avoid this inconvenience, submit your case online before sending in impressions.

If you're still sure you need this form, you can find it here:

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ClearCorrect is a medical device manufacturer and does not practice dentistry. The treating physician is solely responsible for prescribing and administering orthodontic treatment. Clear aligner therapy is unpredictable. ClearCorrect does not guarantee a successful treatment outcome. Individual results will vary.

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