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Implant Services
Crown and Bridge
Removables
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Labs
Pay Online
Send A Case
Resources
Dentists
Resources
Pay Online
Send A Case
Clinical Criteria and Guidelines
Let Us Impress You
Submit A Case
Sending a Crown/Bridge, Removable Case
Sending a Dental Implant Case
Sending a PMMA Case
Upload Completed Prescription
Company
Let Us Impress You
About Us
Our Team
Testimonials
Contact
Careers
Media
Articles
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Sending a PMMA Case
Implant PMMA Rx
Doctor Name:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
*
example@example.com
Phone:
*
Please enter a valid phone number.
Patient Name:
*
Gender:
Please Select
Male
Female
Delivery by 5pm (10 DAYS IN LAB PLUS SHIPPING):
*
-
Month
-
Day
Year
(Please Call for Rush Case)
Select PMMA Prosthesis
PMMA Arch Type
Upper
Lower
Both Upper and Lower
Pink Gingiva Preference
*
Regular Pink AnaxDent Composite
Ethnic Pink AnaxDent Composite
Preference Acrylic
USD Acrylic
Naked (No-Pink)
Implant Manufacturer/Connection/Size
Tooth Shade:
The Shades for PMMA and Zirconia are based off Vita Classic/Vita Bleach shade.
Additional Files, Signature and Information
Additional Information:
Call Doctor
No Call Needed
Email ExoViewer (Approval Required)
Provide Angle Correcting Abutments (Extra Charge Applies)
Notes:
Files
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature:
*
Clear
License #:
Lab Code
Submit
Should be Empty: