Mouth Guard Impression Request

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HomeMouth Guard Impression Request

Orthodontic Experts’ Mouth Guard Impression Scheduling Form

Player First and Last Name *

Parent/Guardian First and Last Name *

Date *

Monday, January 8

Player has braces *

Yes
No

*If the player has braces, please see below.

Player DOB *

Parent/Guardian Email Address *

Parent/Guardian Phone Number *

Team Name

*If player currently has braces, we unfortunately cannot provide a custom-fitted mouth guard for liability reasons. We can provide a free standard mouth guard though, which does not require an impression.

Orthodontic Experts will call the number above to confirm your date/time of mouth guard impression.

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