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"
Mini:
Standard:
Hooks:
Cuspids
Bicuspids:
Hook/Power arm
Ball hook
Upper
and/or Lower
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 & Line:
Prescription:
Slot:
-
.018"
.022"
R
7
6
6
7
L
7
6
6
7
Comments:
Total of tubes:
