Pre-Submission Worksheet

If you prefer to pre-fill a submission form by hand, you can find a pre-submission worksheet here.

These are for in-office use only. We won’t accept PDF’s or paper forms sent via fax, email, or shipment. All cases must be submitted online at


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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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