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

ABUTMENT PREFERRED:


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.
Teeth
Occlusal Considerations
Comprehensive

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.

Pre-Op


Final Preps (ID Master)


Triple Tray


Opposing


Diagnostic Wax-Up


Provisionals


Occlusal Records


Horizontal Transfer


Articulation


Implant Components

Photographs

Portrait


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.