Dental Lab Order Form
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Dental Lab Order Form
1
Step 1:
Case Details
2
Step 2:
Teeth & Shade
3
Step 3:
Upload Files
Case Details
Click to fold
Order Information
Dentist
Clinic
Email
Delivery address
Same as delivery address
Bill address
Patient Name
Patient Age
Sex
male
female
Treatment Type
Digital dental impressions only. Physical impressions are not accepted.
Fixed Restoration
Orthodontics
Implant
Lab Services
Removable Restoration
Type
-- Select Type --
All Ceramic
PFM
Full Metal
Pontic Design
Full Ridge
Partial Ridge
Point Contact
No Contact
Interproximal
Light
Medium
Heavy
Occlusal Contact
Out (0.5mm)
Light (0.3mm)
Full (touch opp.)
If Insufficient Room
Metal Island
Adjust Opposing & Mark
Adjust Prep & Mark Die
Metal Occlusal
Adjust Prep & Reduction Coping
Instructions
Special instructions
0/2000
Tooth Selector & Shade
Step 2
Upload Files
Step 3
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