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Brackets and Tubes
(
to place an order of
bands
click here!
)
To order our brackets and tubes please fill out the form below.
We will contact you soon for order confirmation and payment information.
Doctor's Name:
Name required.
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Address:
E-mail:
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Telephone:
Fax:
Brackets
Manufacturer
& Line:
Prescription:
Slot:
.018" |
.022"
Size:
Mini |
Standard
Ballhooks:
Cuspids
Upper
and/or Lower
Bicuspid
Upper
and/or Lower
No Hooks
R
5
4
3
2
1
1
2
3
4
5
L
5
4
3
2
1
1
2
3
4
5
Comments:
Total of brackets:
Tubes
Manufacturer:
Prescription:
Slot:
.018" |
.022"
R
7
6
6
7
L
7
6
6
7
Comments:
Total of tubes: