Digital Prescription Form


Please complete all of the specified fields below to submit your order for Boutique Whitening trays.

This is supplied when you purchase bleaching gel.
Delivery Options:
Trays required: *
Platform Used: *
Please provide the links to the files here. This helps keep all the information together. However, should this not be possible, please email to boutique@s4sdental.com as well as submitting this form.