Retainer request form

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

If you just want to request a retainer, do not use this form. Go to the doctor's portal, find the case you want to revise, and click "REQUEST RETAINER". More details are available here.

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