Banner Case report

This form was created with the intention of having a detailed collection of clinical cases with all our implant lines. In order to submit this form, you should follow the instructions shown below. Once the material is received, the case will be examined. Based on the complexity of the presented case, C-Tech will decide the amount of free of charge implants to give the practitioner, from 2 up to a maximum of 5 for implant line presented in the case.
It is allowed to present 1 case for each implant line. If more than 1 case is submitted, it will not be possible to benefit from the FOC material. The incompleteness or the non conformity of the presented material will influence the acceptability of the form.

Surgeon details

Surgeon Curriculum (Files accepted max. 3MB: PDF, JPG, JPEG, PNG, DOC, DOCX, ODT) *

Technician details

Technician Curriculum (Files accepted max. 3MB: PDF, JPG, JPEG, PNG, DOC, DOCX, ODT) *

Patient Details

Number of inserted implants *

I° Check Up Time between surgery and first check up

II° Check Up Time between surgery and second check up

Final conclusions

Where there different contraindications aside from the ones listed in the package leaflet? * YesNo

Where there different side effects aside from the ones listed in the package leaflet? * YesNo

Report (min.100 max.3000 Characters) *

Dispatch of photographic material

It's necessary to attach the following material through the "wetransfer" window below:
1 Photo of the Practitioner / 1 Photo of the Technician
At least 2 x-rays (1 before and 1 after the surgery)
At least 9 HQ Photos ( no face or recognizable signs of the patient)

In case inconsistencies or mistakes arise during the revision of the submitted material, C-Tech Implant will communicate the necessary corrections and/or clarifications.

PRIVACY POLICY PROVIDED IN ACCORDANCE WITH REGULATION (EU) 2016/679 ART. 13 | Concerning the protection of personal data
We wish to inform you that, in accordance with Regulation (EU) 2016/679 art. 13, your personal data we hold or that you confer us for business relationship related to the submission of offers or to the stipulation of sales contracts, or through the compiling of online forms on our Website, are object of our IT and manual processing as defined by art. 4 of the same law, according to principles of correctness, lawfulness and transparency for the following purposes:

• Legal obligations connected to civil, fiscal, accounting standards, etc.; administrative management of the relationship and obligations related to the economic activity of the company, including post-sales assistance and credit protection. The personal data provided by you in compiling the "Clinical Case Report Form" (Name and Surname of the Technician and the Surgeon) could be used for information purposes through the publication of the "Case Report Form" in our social media network or in the section "Scientific Publications" of our web page.
• Market analysis and statistics; services and offers on new products, both from us and our subsidiaries.

These data may be communicated and/or disclosed to the companies controlled by us and investee companies, to our sales network, to banks and financial intermediaries, where they are engaged in the execution of our payment orders, to auditing companies, debts recover and other operators involved in the economic and commercial management.

They may also be communicated to the managers of the social media pages and the web page in order to finalize the publication of the "Report Form Per Case" on our computer network.

Any refusal to provide the data, in cases where the conferment is mandatory, has the consequence that the company C-TECH IMPLANT srl cannot fulfill the legal obligations related to civil, fiscal and accounting rules and its contractual obligations and, consequently, to
continue the commercial relationship with your company.

CONSENT DECLARATION (Art.13 Regulation EU 2016/679)

The undersigned identified as Surgeon

The undersigned identified as Technician

in bottom identified, declare to have received complete information in accordance with Article 13 of Regulation EU 2016/679 and express consent to the processing and communication of their own data qualified as personal by the aforementioned decree with particular regard to those so-called sensitive within the limits, for the purposes and for the duration specified in the information.

I AGREE:

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