Clear Aligner Progress Form
Clear Aligner Progress Form
Patient first and last name
*
First Name
Last Name
Date of progress update
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current aligner number
*
Days wearing current aligner
*
How many hours per day are you wearing your aligners?
*
22+ hours
20–22 hours
Less than 20 hours
Have you experienced any discomfort or issues?
*
No issues
Mild discomfort
Significant discomfort
Broken or lost aligner
Other
Describe any discomfort, issues, or concerns (optional)
Upload a photo of your teeth with current aligner (optional)
Upload a File
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Choose a file
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of
Additional comments (optional)
Submit Progress
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