KLS Martin IPS Data Upload Form

Patient Info All fields required.
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Surgeon Info All fields required.
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Case Type & Questions
How will the dental models be provided?
At least one option is required.
Individual Models Non-Segmental Maxilla Segmental Maxilla
Pre-Op Upper Required Required
Pre-Op Lower Required Required
Post-Op Upper (Seg.) N/A Required
Final Occlusion Optional Optional
Will final occlusion be provided?
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Will this be a segmental maxilla?
Please choose an option.
If so, be sure to include the pre-op maxillary dental model.
Distraction
Please provide preferred distractors. 2000 character limit max.
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TMJ
Please indicate the case type
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Please indicate what the data is for
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Will CT be provided?
Requested if previous scan date is not within 3 months of the surgery date or orthodontic movement has occurred.
Please choose an option.
Will dental models be provided?
Mandatory if models were not provided for Stage 1.
Please choose an option.
IPS Products
Please select at least one product or model.
Additional IPS Models
Product Description
PEEK with holes, etc. 2000 character limit max.
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Anatomical Region & Procedure
Left mandible repositioning, LF1 Distraction, etc. 2000 character limit max.
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New Patient?
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If selecting 'Other', please add notes in the Additional Comments box.

If no, describe:

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Additional Comments
Anything else we should know? 2000 character limit max.
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Forms: