San Diego Dental Design CDT b L Implant Technology ... · 12285 World Trade Dr. Ste G San Diego CA,...
Transcript of San Diego Dental Design CDT b L Implant Technology ... · 12285 World Trade Dr. Ste G San Diego CA,...
Dr. Signature:________________________ DDS License# ______________Signature is acceptant of sole responsibility for payment and agrees to pay all legal costs in the event of a suit, including reasonable attorney fees. San Diego Dental Design. requires that each case be accompanied by a lab slip - this is considered a binding work order and is subject to all stated terms and conditions.
Patient Name: ____________________________________________ Age: _______ Preparation Date: ____ /____ / ____ Delivery Date: ____ / ____ / ________________
Dr. Name: _____________________________ Dr. Phone: ______________________
Address: _______________________ City: _________________ Zip Code: ________
Pontic DesignCrown Design
All PFM
NP Tilite AlloySP Semi-preciosHN WhiteHN YellowCaptek
Call for a pickup: (760) 855-709112285 World Trade Dr. Ste G San Diego CA, 92128
San DiegoDental Design
All Zirconia
BruxZirLava HT ZirconiaLayered ZirconiaInlay / OnlayInlay / Onlay
Implant CrownCeramic
PFMCaptek
Zirconia
Screw Retain Pink Gingival Porcelain
Zirconia AbutmentTitanium Abutment
Hybrid AbutmentHader Bar
Abutment & Bar
Placemat Jig
Follow Tissue Contour
RX Number
ProductsCDTConcorde Dental Technician
Lab
Solid CrownLayered CrownFramework Try-in
Shade#
Porcelain MarginBuccal Margin
Metal Margin360 MarginLight
MediumHeavy
ContactLightMediumHeavy
Occl Contact
Please make sure that the due date is 1-2 days before Pt’s appointment dete.
Cement Retain
Surgical Guide
XP
All Ceramic
e.max Crowne.max Veneere.max layeredCeramic Post
please print legibly so we can understand your case better.
XP
Dental DesignImplant Technology
Zimmer • Straumann • Astra Tech • Bio Horizons • Mega’Gen • Biomet 3i • Nobel Biocare