Lords New U Website order form

First name*:

Last name*:

Address*:

City*:

State*:

Telephone*:

Email*:

How did you hear about Lord's NewU Cosmetic Imaging:

Patient Information >>
Patient name*:
Maxillary:
Mandibular:
Gingival Contouring:
Ideal smile:
Whitening:
Teeth coloring:
Lorin Library:

Click here to see all 18 Lorin Library styles

Add another file

Click the browse button to locate your patient’s image file.
Once located click on the submit button to complete
the image upload process.

We will email your patientís NewU Cosmetic Image to you but please let us know if you would like a hard copy of your image mailed to you as well.

(Please allow 5 business days for work to be completed)

Ship hard copy**Email only

Promotional Code

*required information

**$9.95 shipping applies to areas outside Wisconsin,
Upper Michigan Peninsula, and Northern Illinois