Shatkin F.I.R.S.T. Single Patient X-Ray / DICOM Upload Portal
Doctor Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Cell Phone Number
-
Area Code
Phone Number
Patient Name
*
First Name
Last Name
Case Status
*
Case in Transit
Case at Shatkin FIRST
Case Evaluation ONLY
STL file sent (digital model)
Shipping Tracking Info.
Due Date (Date needed in office)
*
-
Month
-
Day
Year
Date Picker Icon
Special Instructions
*
Image Upload
*
Attach File(s)
(if sending multiple files please zip the files before attaching them individually)
Cancel
of
Upload to Shatkin FIRST
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