Customize Your Appliance

    Patient Name

    Patient Phone
    If there are questions regarding your appliance, we will contact you at this number.

    Doctor Name

    Comments
    If you have a specific request for the customization of your appliance that does not include an image, please provide detailed instruction below. Please refer to the Orthotek Color Card to choose your colors.

    Image
    This image should be the exact representation of what will be placed on the appliance. No additional editing will be made. The minimum image width is 80 pixels. If the image provided does not comply with the specified size, we cannot guarantee the quality of the customization.