Better Image Quality - Lower Patient Dose

Image Upload


Please fill out the form below and click the
Submit button to send us your image.

Image files must be one of the following types;
jpeg, jpg, bmp, png, tif, pdf, zip, dex

Note: Fields marked with a red asterisk are required!

Image Upload Form

Please enter the Dentist name.
Please enter the Practice name.
Please enter the Contact name.
Please enter a valid email address for order updates.
Please enter a valid Contact Phone Number in the form '1112223333'.
Please enter the Facility ID or Registration Number.
Please enter the Analyzer Serial Number.
Please enter Todays Date.
Please select a valid image file name.