Straumann Dental Implant Program

For more than a decade, Straumann, an international dental implant company, has been dedicated to helping families affected by ectodermal dysplasias and the NFED. Straumann has committed to donating Straumann dental implants to individuals affected by ectodermal dysplasias who qualify. A family will still be responsible for all other dental care costs associated with receiving the care.

IMPORTANT APPLICATION INFORMATION

This program is designed to benefit individuals diagnosed with an ectodermal dysplasia in greatest financial need.
Your dental team must be willing to use Straumann implants and be willing to work with you on the remaining financial aspect of your dental care.
We encourage you to review our Tips for Finding a Doctor or Dentist, if you are needing resources to get you started in finding a partner for your dental care.
If you are receiving treatment at an NFED Dental Treatment Center, you can also apply to the Straumann Dental Implant Program if you meet the criteria and the center is willing to use Straumann implants.
Straumann will consider donating implants, abutments and related Straumann products such as healing caps as well as CADCAM prosthetics free of charge to individuals affected by ectodermal dysplasias.
All sections of the application must be complete upon submission. Incomplete applications will not be reviewed.
Submission of this application does not guarantee approval. All applications will be reviewed by Straumann who will make approval decisions.

If you have any questions, please direct them to Kayla Hollenkamp at kayla@nfed.org, and she will be happy to assist you.

Download Straumann Application Forms

STRAUMANN DENTAL IMPLANT PROGRAM APPLICATION INSTRUCTIONS

Any individual applying for donated Straumann products must provide the following:

Completed patient application form (page 5).
Be a registered NFED member. If you are not already, you can register your family at nfed.org/join-us/.

Any individual applying for donated Straumann products must have the dentist(s) responsible for the implant treatment complete and share with you the following:

Completed dental provider application form (page 4) including a short outline of the treatment plan and a detailed list of materials needed to properly complete the treatment plan.
Identify and share the name and contact information of the Straumann Territory Representative that services their area. Your dental team can contact Straumann to determine the appropriate person(s).

STRAUMANN DENTAL IMPLANT APPLICATION SUBMISSION

PATIENT INFORMATION
- Patient Name*
  First Last
- Date of Birth*
  MM slash DD slash YYYY
- Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Type of Ectodermal Dysplasia*
- Please Specify Type*
- Guardian Name (if under the age of 18)
- Email Address*
- Phone Type*
- Phone Number*
- Dental Provider's Name*
  First Last
- Dental Provider's Email*
  This email address will be copied on communications with Straumann as they may require additional information from your provider along the way.
- Straumann Territory Representative's Name*
  First Last
- Straumann Territory Representative's Email*
- Please upload the completed patient and dental provider application forms.*
  Drop files here or
  
  Max. file size: 50 MB, Max. files: 4.
- All sections of this application must be completed. Incomplete applications will not be reviewed.
  Check all that apply:
  - I am willing to participate in public relations activities (photographs or stories) related the the NFED’s Straumann Dental Implant Program.
  - I understand that if my treatment plan changes or if I decide to pursue treatment with a different provider that I will need to submit a new complete application for consideration.
  - I give permission to allow the NFED staff to correspond and share information with my dental team and Straumann about my or my child’s treatment.
- By clicking below, I/we hereby confirm that the information provided herein is accurate, correct and complete.*
  Once you submit this form, you should receive a confirmation email at the address provided in the form. Be sure to check your inbox for this message.
  I agree
Name
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