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:
Address:
E-mail:
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:
R 7 6 6 7 L
7 6 6 7
Comments:
Total of tubes: