Southern Craft Dental Lab - Online Rx Form - Southern Craft

Southern Craft

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Forget to send an RX, please feel free to use Online Quick Rx form...

Doctor's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Patient's Name *

First

Last

Restoration Type *

Vita Classic *

Shade Comments *

Define the Tooth/Teeth Being Restored *

Occlusion *

Full Metal Occlusion 2/3 Metal Occlusion 1/2 Metal Occlusion Metal Island Where Needed Porcelain Occlusion

Occlusal Stain *

None Light Medium Heavy

Occlusal Contact *

Out of Occlusion Light Occlusion In Occlusion

If there isn't enough occlusal clearance... *

Relieve the opposing Make a reduction Coping (Not Guaranteed) Call, Text or Email me... Return before fabricating...

Email *

Phone Number *

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Comments/Special Instructions *

Southern Craft Dental Laboratory, Inc. • 2275 Limestone Pkwy. • Gainesville, GA • 30501 • 1.800.532.7554 • scdlcare@me.com