Crown Inlay/Overlay Bonded Bridge/ Wing

Diagonostic Wax-up (Advise Teeth No.)Veneer Post & Core

Bridge

C R O W N A N D B R I D G E W O R K

RESTORATION TYPE

MATERIAL ENCLOSED

TOOTH CHART

SHADE

ADDITIONAL INSTRUCTIONS

CAN SCULPT DECIDE?

Adjust the opposing and mark on model or Estimate and email to adviseMake a reduction coping to show where to adjust the preparation

I would like these preferences to be a permanent note for all future cases

Please tick to minimise delays in case of problem

Insufficient Occlusal Clearance Suspected incorrect occlusion

Estimate and email to advise

Margins not clear / distortion on impression

Composite Reinforced with:

Non-Precious Be-Free

IPS e.max®**

PFZ - Porcelain-Fused-to-Zirconia**

Low-Precious 2%

Fibre

UZir - Ultra Translucent Zirconia**

Semi-Precious 40%

Metal

Titanium

FMZir - Fully Monolithic Zirconia

High-Precious 86%

No extra reinforcements

Temporary Crown (PMMA)

Metal-based PFM

Full Cast Metal

Ceramic

Gold Content

Resin

(please email images)

Stump ShadeEMBRASURE

Open Closed*

*Default

OCCLUSAL CONTACT

Light* Open Heavy

PROXIMAL CONTACT

Extended*Normal

PONTIC CONTACT

*

Triple Tray

Lower Impression

Lower Model

Previous Veneers/Crown/BridgesArticulator

Veneers

P/C (Post Core)

Upper Impression

Upper Model

Bite Registration (over prepared abutment)

Denture

Implant Component

Shade Tab

Images to be emailed

Please tick �

Upper Lower

Anterior Posterior

SCULPTBATCH # (Office use only)

I M A G I N E E R I N GS M I L E S

Due date

Clinician

Clinic Address

Patient Name Date

New Case Continuation/Remake

EMAIL IMAGES info@sculptdental.com.au

SHIPPING ADDRESS

QLDNow Receiving Cases

VICNow Receiving Cases

NSW - SYDNEYLevel 128 Grose StreetParramatta NSW 2150

02 9713 7580 02 9713 7580 02 9713 7580

NSW - NEWCASTLE Shop 2593-595 Main RdGlendale NSW 2285

02 4903 4255

ACT - PHILLIP 65 Colbee Court Phillip ACT 2606

02 6281 0099

You

**Provide stump shade if non-vital

Low-Precious 2%Semi-Precious 40%High-Precious 86%

Sculpt Dental LaboratoryTERMS AND CONDITIONS OF BUSINESS

Meanings

a. Below are the Terms and Conditions of Business of Sculpt Dental Laboratory (hereafter referred to as ‘SDL’ ‘it’ ‘us’ ‘we’, or ‘our’).b. SDL reserves the right to change, add to, or delete these terms at any time. Any changes to the terms and conditions of business shall be published on our website at

www.sculptdental.com.au. You may refer to our website at any time to keep abreast of changes.

Acceptance of Terms and Conditions

c. Any order or instruction received by SDL from the client for the supply of products and/or services will amount to acceptance of these terms and conditions of business.d. When these terms and conditions of business are accepted by the client, it shall be binding and can only be changed with express written permission of SDL.

Provision of Credit

e. SDL reserves the right not to accept an order for products and/or services from any client.f. SDL reserves the right to request advance payment from any client. Credit is given to the client based on SDL’s sole discretion, and may be withdrawn at any time.

Price & Payment

g. The price of our products and services are outlined in writing by SDL to the client. Prices are subject to change without notice. The client can obtain a current price list from SDL Client Support, email info@sculptdental.com.au or download from www.sculptdental.com.au.

h. GST and/or other taxes as applicable will be added to the price, to meet relevant state or federal legislation.i. Where credit has been extended by SDL, invoices are due for payment strictly 30 (thirty) days from statement date. Balances outstanding over 30 days may incur in interest

and admin fees.

Service & Logistics

j. All items sent to SDL must be decontaminated in accordance with the Guidelines for Infection Control set by the Dental Board of Australia.k. All items sent from SDL have been decontaminated in accordance with the Guidelines for Infection Control set by the Dental Board of Australia.l. The client takes responsibility for the safe and timely shipping and delivery of jobs sent to SDL for processing. SDL is unable to take responsibility for jobs that are damaged,

delayed or lost in transit to SDL. m. Payment of costs of shipping and delivery to SDL is the client’s responsibility.n. Depending on the product, standard turnaround times for jobs are approximately 6-8 in-lab days, from the time SDL receives the package. This is conditional and depends

on there being no delays due to factors beyond SDL’s control. o. Cases may take longer than the stated turnaround time above where there are technical queries from SDL technicians, potential issues to discuss, or where photos are

requested by the client.p. SDL takes responsibility for the delivery of a completed job back to the client.q. SDL will make delivery of the completed job to the clinic/business address of the client.

Provision of Guarantee

r. SDL offers a guarantee on all Crown and Bridge work – except veneers, inlays or onlays – for any defects or fractures that happened as a result of our manufacturing process(the Guarantee).

s. Where SDL agree to replace the defective product, a new item will be made to the identical specifications of the original product. Substitute materials will not be accepted whatsoever.

t. The above Guarantee is conditional on the following:1. The Guarantee is valid for the following Products only from the date of original invoice to the client for the specified period below:

i. Crowns – excluding fully milled zirconia and layered zirconia – for a period of 5 (five) years;ii. Fully milled 100% zirconia for a period of 10 (ten) years; andiii. Layered zirconia crown framework for a period of 10 (ten) years; complete restoration for a period of 2 (two) years.

2. The damaged/defective Product must be returned to SDL for inspection/verification.3. SDL will assess the Product to determine, in its sole judgement and discretion, whether a full or partial refund, or a replacement Product will be provided.4. The Product will be remade for the client by SDL in accordance with clause t3 above, except that semi-precious or high-precious metals or new components for implant

cases will be charged for.5. The Guarantee extends to the replacement Product provided except where, in the opinion of SDL, the material selected by the client has a higher than usual chance of

fracture or defect.u. SDL reserves the right to void the Guarantee if, in its sole judgment, the damage to the Product was not caused as a result of our manufacturing process.v. The Guarantee is offered to clients who have obtained the Products from SDL and is not intended to exclude or limit any rights or remedies a client may have under the

Australian Consumer Law.

Medical Advice

w. SDL will provide products or services to the client based on the order sheet provided by the client, and may from time to time discuss the case with the client via telephone – including text messages – email or in person. The client acknowledges that such discussions, and any representations by SDL, should be used only as a guide rather thana definitive recommendation to adopt any specific course of action or treatment.

x. Nothing transmitted/communicated in the course of such discussions shall constitute the establishment of a doctor-client-patient relationship between the client and SDL. y. Responsibility for the diagnosis of any medical condition, and for the prescription of treatment planning or medicines, remains solely with the client.

Governing Law and Jurisdiction

z. These Terms and Conditions of Business are governed by the laws of the state of New South Wales. No action or proceeding may be initiated or maintained in relation tothe site, the Services or these Terms and Conditions except in a court of appropriate Jurisdiction in the Commonwealth of Australia.

PRIVACY STATEMENT

Sculpt Dental Laboratory (SDL) ABN 68 119 117 850 collects your personal and/or business information so we may provide you with superior service and products. SDL may not be able to do this if your personal and/or business information is not collected. If required, SDL may disclose your personal and/or business information to our manufacturing and marketing associates. When you provide us with personal and/or business information about a third party, you should present them with a copy of this Privacy Statement.

SDL’s Privacy Policy contains instructions on how you can get hold of and/or ask for amendments to the personal and/or business information we hold about you. The policy also tells you how you may make a privacy complaint as well as how we deal with complaints. The policy can be accessed at www.sculptdental.com.au, or email us on info@sculptdental.com.au or call us on 02 9713 7580 to get a copy.