Forms › Comprehensive Prescription

We want to deliver accurate cases for your patients. Our Comprehensive Prescription Form helps us meet your expectations on every case. Please complete and submit the form below.

Step 1: Client Information
Need Supplies
Lab Please Call to Discuss
Preferred Means of Communication
Step 2: Patient Information
Step 3: Work Authorized
Diagnostic Wax-Up
Provisional Restorations
Anterior Restorations

(Single Units, All Ceramix, Monolithic, Pressed,
Stained and Glazed)

Posterior Restorations

Bridge Pontic Design
Implant Case


Esthetic Considerations

  • To be drawn in diagram below.

  • To be drawn in diagram below.

  • To be drawn in diagram below.
Type/Material of Restorations(Applies to "ORIGINAL" and "MASTER" level restorations)

Ceramic Margin:

All Ceramic:

Full Cast Crown/Onlay:

Shade Information
View Download/Upload instructions here.
Occlusal Considerations

For information regarding expedited service opportunities/remake/adjustment policy and payment terms, please see our Price Sheet.

Step 4: RX Notes

Please list any notes or comments for this case here:

Step 5: Items Checklist
Working ItemsPlease indicate quantity of each item sent.


Final Preps (ID Master)

Triple Tray


Diagnostic Wax-Up


Occlusal Records

Horizontal Transfer


Implant Components



Portrait with Eyes Horizontal & Lips Retracted, Incisal Edges 2mm Apart

Maximum Smile

Lips in Repose

Lips Retracted in ICP

Lips Retracted Incisal Edges 2mm Apart

Shade Tab

Horizontal Transfer

Step 6: Submit
  1. 1. Click "Download New Blank Diagram" to access the diagram.
  2. 2. Print downloaded diagram and complete.
  3. 3. Detailed instructions on how complete and upload the diagram are noted on the document.