Project mouthguard



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Date04.02.2017
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PROJECT MOUTHGUARD

MAIL-IN PROGRAM


If you play a sport where there is a chance for contact with another player, the playing equipment or the playing surface, the Hawaii Academy for Sports Dentistry (HASD) strongly recommends that you wear a custom made mouthguard. The benefits are described in our educational pamphlet. As part of Project Mouthguard, you can get a custom made mouthguard by following these simple instructions. You will need to have an impression of your mouth taken by your dentist. After HASD receives your model, a custom made mouthguard will be mailed to you. Take the form below to your dentist and mail the completed form, your model and a check or money order (to HASD) for $15 to:
Hawaii Academy for Sports Dentistry

50 S. Beretania, Suite C-201

Honolulu, HI 96813
You will receive a custom made mouthguard in a short time. If you want a container for the mouthguard, add $1. If you do not have a dentist, call HASD and we can arrange for you to be seen by one. There are special team or school rates. For more information or any questions, email HASD at: choyddsm001@hawaii.rr.com.
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Dear Doctor:

Please take a maxillary impression (mandibular, if prognathic) and pour in coecal stone or harder. Do not make the total model height more than 25 mm. If you can fabricate a vacuum formed mouthguard as part of Project Mouthguard, please do so and charge your patient $15 for the mouthguard. If you are unable to participate, please give your patient the model to mail to HASD. If you have any questions, call HASD at 536-4026. Mahalo.
Hawaii Academy for Sports Dentistry
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To be completed by patient and mailed with model:


Name______________________________Age______School_______________

Address_____________________________

______________________________

Phone___________________ Sport(s) participating in:_______________________


Dentist name:__________________________
Color choice: 1st_________________2nd________________3rd_________________
Please include a mouthguard container:_______


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