This page provides all the details on how to submit your practice contact information for a customized
product you purchased from us. The forms below can be downloaded and then emailed or faxed back to us.
They can also be completed online. Whatever method you choose; we need these forms returned before
ANY customization work can begin on your product(s)! If you have have any problems or issues sending
the release form then simply email us and we can assist you.

After you have submitted this information you can then submit photos via our ONLINE UPLOAD FORM
or by simply emailing them.

The forms and instructions are provided in Microsoft Word and PDF format.
Click the links below to open the file in a new window or right click them and "save as" to save to your
computer's hard drive.

Microsoft Word Format:

Adobe PDF Format:

You can also fill out our practice contact information form online by clicking HERE

Remember, these forms MUST be returned for any customization work to begin on your kit. It can take up
to 21 business days AFTER you supply your practice info and pictures to get the kits customized We
understand a lot of doctors are very busy, so if you will be needing a few days time to complete the forms
just let us know. If you can't fill these forms out for whatever reason simply let us know and we can send
the form for you to fill out via email.


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