Member's Replacement Order Form | SmileStay Retainers

To ensure the best fit, we require a current 3D scan. Changes to your teeth since your last scan - including going without your retainer for more than a week - may affect how your retainer fits. Please contact our team if you’ve experienced any changes.

I have read and understand this statement.

Patient's Name (if ordering for someone else, enter their name)

Patient's Date of Birth

Replacement Retainer Type

Orthodontist's Name

Is your orthodontist still moving your teeth?

Yes

No

I'm not sure

When did you last wear your retainer?

Does your retainer require an artificial tooth? If yes, please be aware that these orders can have a longer turnaround time than standard retainers.

Has the patient had any recent or upcoming dental work (e.g., crowns, fillings)? If yes, please include the date (day, month, and year if known).

Which best describes your current retainer situation?

Select all that apply.

Email Address (use your preferred email for order updates)

Once you submit your request, please watch for an email to complete payment. After payment is processed, your retainer will be shipped within a few days. If you have any questions, feel free to reach out through our contact form.

Request Replacement