Patient registration form for using the OrthoPulse App

First name

Last name

your birthdate

Gender Gender Female male

E-Mail-Address to send your credentials

Your mobile phone (to send credentials by SMS) please use international format!!

Serialnumber of your OrthoPulse (12 digits after (21) found at the bottom of the charger case)

Start date of your treatment

Please select the type of your treatment Please select the type of your treatment braces aligners

Total number of aligners

After how many days your doctor prescribed to switch to the next aligner?

Anything else you wanted to tell us?

Please accept our privacy policy so we can create an account for you. When you first log into your new account you will also need to accept the data privacy policy (please do this wihtin 14 days of receiving your credentials) Please accept our privacy policy so we can create an account for you. When you first log into your new account you will also need to accept the data privacy policy (please do this wihtin 14 days of receiving your credentials) Accept privacy policy