Patient Name * First Name Last Name Number Of Teeth (Top) * 1 2 3 4 5 6 7 8 9+ 0 Number Of Teeth (Bottom) * 0 1 2 3 4 5 6 7 8 9+ Metal Type * Silver925 10KT 14KT 18KT Color * Natural Silver Gold Plating Rose Gold Plating 10KT Gold 10KT White Gold 10KT Rose Gold 14KT Gold 14KT White Gold 14KT Rose Gold 18KT Gold 18KT White Gold 18KT Rose Gold Stones * Moissanite CZ Stones What would your patient like? * Thank you!