Reva digital denture

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Reva digital denture_ Order Form

Thank you for having interested in Reva digital denture. Please fill the necessary information to complete your order.
◆ Note:

1. This is order form for final denture fabricating. Click the link below if you only want to order design service.
https://forms.gle/QTTLctuwef5Sp32Z6

Best regards.
2. Downloadable hand writing Instruction file is here:
https://drive.google.com/file/d/1noEefZ9o2DOtvvJmcM979Czz9_SO0YFq/view?usp=sharing

Please send the file full filled with your data via the following email address.

◆Contact:
Bitec Global Japan Inc
International Sale Team

Email: info_int@bitecglobal.com
HP: https://www.reva-digital.net/
Phone: +81-3-5546-0877 (Services and Technician inquiries)

Email *

1. Fill in date　　　　　 *

YYYY

2. Clinic name *

3. Name of dentist in charge *

4. Clinic address *

5. Phone number *

6. Patient name *

7. Patient ID (which was created in your Clinic) *

8. Agent Information (Agent company name, Tel and Email address) *

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