Please use a street address as we cannot deliver to PO Boxes.
FRLA treatment requires completion of the Rapid Appliance prescription. Please ensure you complete the appliance prescription with a matching patient name:
Rapid Appliance (http://Appliance.rapidsmiles.com.au)
Lateral Ceph must be provided with all Dr Galella Reviews.
Please note that Case Reviews will incurr a $65 fee.
Please drag and drop all patient images in the box titled "Upload Images Here",
We encourage as many of the sample images below as possible for successful case submission. You may also upload additional files such as:
Please note that STL files will be uploaded in a later section of this form.
Please hover over each image once dropped into the upload section & confirm you have copied the correct files, and ensure you press "Begin Upload."
Intraoral Scan Files
If you use an Intraoral scanner, please export all files in STL file format and upload here.
You must supply 2 STL Files otherwise the case will be rejected. Please label with patient first & last name, and upload, eg:
in the below Intraoral STL File Upload box. If the STL files are larger than 20MB, please zip the files prior to dragging across and uploading.
Please Press "Begin Upload" to start the upload of your STL files before progressing to the next page.
If you do not have an Intraoral scanner or are unable to upload STL files, we are able to scan patient models on your behalf.
Please ensure we receive your models in a timely fashion, as all lead times are calcuated from completed applications have been received & approved.
Please ensure you follow the Model Guidelines and Case Submission documents below to ensure timely progression of your case.
Whilst we endeavour to expedite every case, processing times can vary.
In order to ensure the most expeditious processing of your case, please ensure that all the necessary Case Submission information below is provided:
Allow a minimum of 2 weeks from receipt of completed Case Submission to delivery.
NB: Please confirm delivery date before scheduling your patient visit.
All correspondence regarding this case will be directed to the email address below. Plesae ensure your have entered the correct details as this will adversely affect the delivery time of your script. If you need to change this address, please re-visit the first page of this form.
Please ensure you have included all of the following items before submitting this form.
You must upload patient images to submit this prescription.
You must upload STL Files to submit this prescription.
Please be patient after you have pressed submit. The upload process may take a number of minutues, however when completed succesfully the page will refresh and confirm sucessful submmission.