Retainer Patients Dentists, Orthodontists & Doctors
 
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Thank you very much for your interest in the All-Wire Retainer.

If you are a patient, please visit our PATIENTS page to read about the steps necessary for you to receive the All-Wire Retainer. If you are an orthodontist or dentist, please continue reading.

The All-Wire Retainer is an “Acrylic Free” retainer that is designed with an entirely new concept in mind.  As you can see, through the introduction on our web site, it is very different from other existing retainers. We believe you will understand how amazing the All-Wire Retainer is once you try it. 

Please fill out the attached form and click SUBMIT. After confirmation that we have been contacted by an orthodontist or dentist, we will send an information packet containing prices and other important details of the All-Wire Retainer.

We can only send further information to Orthodontists and Dentists. As soon as we receive the required form below, we will contact you with a confirmation. If we are unable to confirm that the request is from an orthodontist or dentist, the information packet will not be sent.
INFORMATION REQUEST FORM
All fields in BOLD are required
Dr. / Clinic Name  
Contact Person  
Address (line 1)  
Address (line 2)  
City, State and Zip  
Country
(USA and Canada only) 		 
Phone  
Fax  
Email Address  
Current Retainer Type
   Hawley Type Wrap Around Essix Crozat Type 
Other
How long has your patient been instructed to wear a retainer?

First hours per day

Following
 hours per day
How did you find us?
  
from patients website
ad
Other
Question / Comments  
   


Privacy Policy: All-Wire Retainer does not rent, sell, or share personal information about you with other people or non-affiliated companies except to provide products or services you've requested.

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Island Retainer, LLC
All-Wire Retainer