If you prefer to pre-fill a submission form by hand, we offer a pre-submission worksheet 3 different notations including:
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 dr.clearcorrect.com.
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480.126_en_A_01_10_19_Pre-Submission_Worksheet_(Universal).pdf
900 KB Download
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480.126_en_B_01_10_19_Pre-Submission_Worksheet_(Palmer).pdf
900 KB Download
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480.126_en_C_01_10_19_Pre-Submission_Worksheet_(FDI).pdf
1000 KB Download
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480.126_ja_A_00_10_19_Pre-Submission_Worksheet_(Universal).pdf
1 MB Download
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480.126_ja_B_00_10_19_Pre-Submission_Worksheet_(Palmer).pdf
1 MB Download
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480.126_ja_C_00_10_19_Pre-Submission_Worksheet_(FDI).pdf
800 KB Download
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480.126_pt br_A_00_10_19_Pre-Submission_Worksheet_(Universal).pdf
800 KB Download
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480.126_pt br_B_00_10_19_Pre-Submission_Worksheet_(Palmer).pdf
800 KB Download
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480.126_pt br_C_00_10_19_Pre-Submission_Worksheet_(FDI).pdf
800 KB Download
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480.126_fr_A_00_10_19_Pre-Submission_Worksheet_(Universal).pdf
2 MB Download
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480.126_fr_B_00_10_19_Pre-Submission_Worksheet_(Palmer).pdf
1000 KB Download
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480.126_fr_C_00_10_19_Pre-Submission_Worksheet_(FDI).pdf
1000 KB Download
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480.126_es_A_00_10_19_Pre-Submission_Worksheet_(Universal).pdf
2 MB Download
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480.126_es_B_00_10_19_Pre-Submission_Worksheet_(Palmer).pdf
1 MB Download
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480.126_es_C_00_10_19_Pre-Submission_Worksheet_(FDI).pdf
1 MB Download
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480.126_it_B_00_07_20_Pre-Submission_Worksheet_(Palmer).pdf
900 KB Download
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480.126_it_C_00_07_20_Pre-Submission_Worksheet_(FDI).pdf
800 KB Download
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480.126_it_A_00_07_20_Pre-Submission_Worksheet_(Universal).pdf
2 MB Download
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480.126_de_A_00_07_20_Pre-Submission_Worksheet_(Universal).pdf
1000 KB Download
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480.126_de_B_00_07_20_Pre-Submission_Worksheet_(Palmer).pdf
800 KB Download
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480.126_de_C_00_07_20_Pre-Submission_Worksheet_(FDI).pdf
1 MB Download
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