Please read before completing the form

Please note that this form requires a minimum of 10 images to be uploaded and must include an image(s) of EthOss Bone Graft being placed. If your case consists of fewer than 10 images, please contact us via email to discuss alternative submission options.

Tell us about yourself

First name*

Last name*

Email*

Phone number*

Country / Region*

Patient medical history

Does the patient smoke?*

Yes

Patient age*

Gender*

Relevant medical history*

Treatment plan*

Upload your images

We require radiographs and time frames for a successful submission. Please see our past case study books for reference.

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