Traditional case pickup

Request a pickup.
Send the Rx ahead.

Complete the prescription below before the physical case is collected. Your preferred pickup time is a request until confirmed by the studio.

Digital prescription

Traditional Case Rx

Use a case reference or initials and include only the information needed for laboratory review.

01 Practice & schedule

Clinic nameDoctor / clinician nameEmailPhoneDental clinic addressPreferred pickup datePreferred pickup timeCase reference / account no.Requested due date

02 Patient & restoration

Patient initialsAgeGenderArchTooth numbers — FDI notation

03 Design & aesthetics

Main shadeStump / prep shadeTranslucencyOcclusionContact, texture & lusterPontic design

04 Records & instructionsSpecial instructions

I am authorized to submit this case and have included only the information required for laboratory review.

Requested dates are reviewed by the studio and are confirmed only after follow-up.