Bücco - Ortho guide
Refer a patient in orthodontics

Refer a patient in orthodontics

Clinic


Orthodontist



Patient information


This address will be used to send you a confirmation of receipt and / or consultation report.

Treatment required







Additional Information

Complement




Patient communication



Imagerie: (3 maximum)
-Radiograph(s)
-Photo(s)

Format Jpg, pdf, txt, maximum 10 mega-bytes each

You are not digital? Nothing more simple, take a picture of your x-ray with a smartphone and send it to your email. Then download this image on your computer. From this form, select that image. Repeat this process for all your X-rays and photos.


Fields marked with an asterisk (*) are required.