WELCOME PREFERRED PARTNER! · Space Maintainers & Regainers. Fierce Mouthguards - Level 6 $ 70.00 Band and Loop Space Maintainer $ 45.00 Distal Shoe $ 50.00. Study Models. Space Regainer

Practice confidence.

N B C C E R T I F I E D | F D A A P P R O V E D M A T E R I A L S | N A D L M E M B E R

Call DDS Lab directly

(877) 337-7800Everything you need to send your 1st case

www.ddslab.com/send-a-case

Dear Doctor,

Thank you for your interest in DDS Lab. Included in this starter kit is our exceptional pricing on dental laboratory products and services. DDS Lab is a full-service, NBC-certified dental laboratory that specializes in crowns, bridges, dentures, partials, implants, orthodontics, Fierce® mouthguards and CAD/CAM restorations.

Dental restorations are manufactured and/or distributed by DDS Lab, LLC, 5440 Beaumont Center Blvd, Suite 400, Tampa, FL 33634. DDS Lab is a full-service dental laboratory with the following memberships and certifications: NBC Certified Dental Laboratory (CDL #123252-00), FDA registered (FDA #3004632064, 3009687180, 3009319807) and National Association of Dental Labs (NADL #122122-0).

MYDDSLAB MOBILE APP Track your cases 24/7 and upload case images right from your mobile device!

WELCOME PREFERRED PARTNER!

QUALITY

CUSTOMERSERVICE

TECHNICALSUPPORT

ON-TIMESHIPMENT

ONLINE TOOLS

BUSINESS SOLUTIONS

x Our zirconia solids from DDS Lab are the best we have seen. I thought the local lab we used for the last 10+ years couldn’t be beat. Well, these are better fitting, better esthetics and quicker turnaround time.”

– Hollywood Park Dental, TX

SENDING OPTION 1

STANDARDSENDING OPTION 2

RUSH-CASESENDING OPTION 3

MyDDSLab.comPRODUCT

CATEGORY

Paper Rx and Physical Impressions.

Expedite your case for an additional fee of $50. Reduce your turnaround time by

up to 7 days.

MyDDSLab.com allows you to

decrease turnaround time and avoid RX errors during case

submissions.

FIXED PRODUCTS

REMOVABLE PRODUCTS

COMBINATION PRODUCTS

IMPLANT PRODUCTS

ORTHODONTIC PRODUCTS

Standard cases

Complex cases*

Repair cases

Standard cases

Repair cases

Base Plate/Bite Rim/Custom

Custom abutment

Stock abutment

Screw retained

Standard cases/Retainers

Bonded 3x3 Retainers

Combination Cases*

10 Business Days

13 Business Days

10 Business Days

10 Business Days

10 Business Days

48 Hours In Lab

13 Business Days

13 Business Days

13 Business Days

10 Business Days

7 Business Days

13 Business Days

7-9 Business Days

10-12 Business Days

7-9 Business Days

7-9 Business Days

7-9 Business Days

N/A

10-12 Business Days

10-12 Business Days

10-12 Business Days

7 Business Days

N/A

10-12 Business Days

10 Business Days

13 Business Days

10 Business Days

10 Business Days

10 Business Days

48 Hours In Lab

13 Business Days

13 Business Days

13 Business Days

10 Business Days

7 Business Days

13 Business Days

CHOOSE ONE OF OUR SENDING OPTIONSAND SHORTEN YOUR TURNAROUND TIME

*Complex Cases: 7 or more units in one case and/or 2 or more di�erent materials*Combination Cases: 2 or more products in one case; fixed, removable, implant

Turnaround time measurements begin when the case is received at DDS Lab Tampa and end when the case is delivered to the customer. These dates do not include the shipping time from your o�ce to the lab.

Sign up for MyDDSLab.com: http://go.ddslab.com/register_mydds_labLearn how to send a digital impression: https://www.ddslab.com/how-to-send-a-digital-impression

DIGITAL MODELESS

Zirconia HT/Zirconia Solid 5 Business Days 3 Business Days 5 Business Days

Miscellaneous$ 87.00 Porcelain Butt Margin 360° 25.00$

119.00$ Porcelain Butt Margin 180° 15.00$

Metal Lingual 25.00$ $ 64.00Metal Occlusal 10.00$ $ 54.00Metal Margins 360° 10.00$ 168.00$ Bridge Connector 3.00$ 140.00$ Rest Seat 15.00$ 76.00$ Crown & Bridge Repair 16.50$ 71.18$ Shade Change 23.00$ 43.75$ Temporary Crown 30.00$ 53.00$ Adapt Crown to Partial 30.00$ 202.00$ Diagnostic Wax Up - Per Tooth 30.00$ 180.00$ Digital Printed Models $ 10.00

Rush Case per unit $ 50.0074.00$

Shipping - Per Case (roundtrip) FREE$ 89.00

$ 83.00

$ 112.00

$ 120.00

$ 84.0069.00$

$ 90.00$ 56.00$ 56.00$ 54.00

Digital Impression SystemsDigital impressions are a convenient way for your practice to save time and money. We accept iTero™, Sirona’s CEREC®, and 3M ESPE’s Lava™ C.O.S.

Be sure to add DDS Lab to your list of favorite labs.

5440 Beaumont Center Blvd, Suite 400 | Tampa, Florida 33634Phone 877.337.7800 | www.ddslab.com

Pricing is confidential. © 2018 DDS Lab. All rights reserved.

Crown and Bridge

MetalWhite Hi-Noble - PFM

Yellow Hi-Noble - PFM

Semi-Precious - PFM

Non-Precious - PFM

Full Cast Gold (Yellow Hi-Noble)

Full Cast Gold (White Hi-Noble)

Full Cast Yellow Noble (2% AU)

Full Cast (Semi-Precious)

Full Cast (Non-Precious)

White Hi-Noble Post & Core

Maryland Bridge (Hi-Noble)

Maryland Bridge (Semi-Precious)

Metal FreeIPS e.max®

IPS e.max® Inlay/Onlay

IPS e.max® Veneer

IPS e.max® No-Prep Veneer

IPS e.max® Post & Core (Cosmo Post)

Zirconia Layered

Zirconia HT

Zirconia Solid

Composit Inlay/Onlay

Proud Partner Lab of Dental Success Network

Denture Setup Finish Mouth/Night GuardsPremier™ $ 165.00 $114.00 $51.00 Mouth/Night Guard Soft 50.00$ Elite™ $ 115.00 $68.00 $47.00 Mouth/Night Guard Hard 67.00$

Surgical $ 105.00 $65.00 $40.00 FlexiGuard Flexible/Hard 111.00$

Fierce Mouthguards - Level 1 25.00$

Metal Partial Setup Finish Framework Fierce Mouthguards - Level 2 38.00$

Premier™ Partial (Vitallium Framework) 211.00$ $70.00 $46.00 $95.00 Fierce Mouthguards - Level 3 46.00$

Elite™ Partial 187.35$ $53.00 $46.00 $88.35 Fierce Mouthguards - Level 4 54.00$

Valplast® w/ Metal Substructure 188.10$ $53.75 $46.00 $88.35 Fierce Mouthguards - Level 5 63.00$

CustomFlex™ w/ Metal Substructure $ 170.00 $46.00 $45.00 $79.00 Fierce Mouthguards - Level 6 70.00$

Cast Metal Framework Only 88.35$ Helmet Strap 5.00$

MiscellaneousMetal Free Partial Try In Finish Bite Rim 12.00$

Valplast® 128.25$ $82.25 $46.00 Base Plate 15.00$

CustomFlex™ Partial 91.00$ $46.00 $45.00 Reline 59.00$

Acrylic Partial 125.00$ $79.00 $46.00 Repair Simple 38.00$

Surgical Partial (5+ teeth) 115.00$ $69.00 $46.00 Repair Complex 49.00$

Rebase 70.00$

Flipper (1-4 teeth) 75.00$ Soft Liner 100.00$

Cosmetic Clasp 36.00$ Custom Trays 17.00$

Bleaching Tray 20.00$

Wrought Wire Clasps 13.00$

Patient ID 11.00$

Metal Mesh 30.00$

Rush Case (per unit) $ 50.00

Shipping - Per Case (roundtrip) FREE





Removable Prosthetics


Retainers CrossbitesHawley Retainer $ 35.00 Anterior Incline Plane $ 50.00

Wraparound Retainer 40.00$

San Antonio Retainer 41.00$ Molar DistalizingSimple Spring Retainer 41.00$ Hilgers Pendex $ 90.00

Modified Spring Retainer 45.00$ T-Rex $ 90.00

Super Modified Spring Retainer 50.00$ Molar Distalizing Sagittal $ 100.00

Bonded Retainer (3X3) 29.00$

Essx Retainer 32.00$ Holding AppliancesInvisible Retainer 32.00$ Lingual Arch (Bi-Lateral Space Maintainer) $ 32.00

Removable Lingual Arch $ 36.00

Arch Development Nance $ 36.00

Schwartz Appliance $ 77.00 Transpalatal Arch $ 29.00

Double Screw Schwartz $ 77.00

3-Way Expander $ 90.00 Banding/AttachmentThree-Way Sagittal $ 98.00 Spring $ 5.00

Quad-Helix $ 43.00 Buccal Tubes $ 6.00

Bi-Helix $ 43.00 Add Anterior Bite Plate $ 15.00

Rapid Palate Expansion (R.P.E.) $ 56.00

Bonded R.P.E. $ 77.00

Haas Palatal Expander $ 65.00





Orthodontic


Functional Orthopedics Fierce MouthguardsBionator to Close (Bionator II) 119.00$ Fierce Mouthguards - Level 1 25.00$

Bionator to Open (Bionator I) 119.00$ Fierce Mouthguards - Level 2 38.00$

Twin Block with Screw 169.00$ Fierce Mouthguards - Level 3 46.00$

Twin Block McNamara 169.00$ Fierce Mouthguards - Level 4 54.00$

Fierce Mouthguards - Level 5 63.00$

Space Maintainers & Regainers Fierce Mouthguards - Level 6 70.00$

Band and Loop Space Maintainer 45.00$

Distal Shoe 50.00$ Study ModelsSpace Regainer w/Active Loop 35.00$ Study Model Finished 42.00$

Looped Coil Space Regainer 36.00$ Pour Work Model 7.00$

Sliding Loop Space Regainer 45.00$

Fixed Pedo Partial (bands & 4 pontics) 75.00$ Options / Add-onsFlipper (up to 3 teeth) 50.00$ Anterior Bite 10.00$

Posterior Bite 10.00$

Splints Acrylic with Labial Bow 10.00$

Hard Night Guard 67.00$ Reverse Incline 15.00$

Soft Night Guard 50.00$ Wire Extension (2 teeth) 5.00$

Mora-Gelb Splint (includes articulation) 65.00$ Reset Teeth 5.00$

Deprogrammer 79.00$ Additional clasps 10.00$

FlexiGuard (Hard-soft) 111.00$ Pontic 15.00$





Orthodontic (cont.)


Our implant specialty team is knowledgeable, experienced and well-trained to support implant cases. By providing the dentist with carefully prepared case treatment planning, we can complete each fabrication stage to a skillful conclusion.

DDS Lab supports dental implant fabrication for almost all recognized systems.

Below are several implant packages that are offered:

IMPLANTS AND SURGICAL GUIDES

Practice confidence.

Implant Product Packages Technical Specifics Price Turnaround

Screw Retained Implant Package Soft Tissue Model, Lab Analog, Placement Screw, Ti Interface, Solid Zirconia Crown

$305 13-Day TAT

Aesthetic Screw Retained Implant Package

Soft Tissue Model, Lab Analog, Placement Screw, Ti Interface, Zirconia Crown with Porcelain Facial

$375 13-Day TAT

Custom Titanium Abutment Package

Soft Tissue Model, Lab Analog, Gold Nitride Ti Abutment and Cementable Zirconia or PFM Noble CrownExtra Alloy Charge for PFM-WHN or YHN

$305Must specify “standard package” for $299 price

13-Day TAT

Zirconia Abutment /IPS e.max Package

Soft Tissue Model, Zirconia Abutment, Lab Analog, IPS e.max® Crown

$500 13-Day TAT

Titanium Hybrid Denture(up to 5 implants)

Lab Analog, Soft Tissue, Bite Rim, Verification Jig, Titanium Milled Bar, Premium Denture Teeth

$2,200 Please Call

Titanium Hybrid Denture(6 or more implants)

Lab Analog, Soft Tissue, Bite Rim, Verification Jig, Titanium Milled Bar, Premium Denture Teeth

$2,700 Please Call

All Zirconia Screw Retained Bridge

Soft Tissue Model, Lab Analog, Bite Rim, Verification Jig, PMMA Bridge with Pink Composite & Solid Zirconia Screw Retained Bridge with Pink Composite

$3,000 Please Call

Surgical Guides Please call to determine the best surgical guide to use $399 Please Call

Turn

arou

nd t

imes

cal

cula

ted

from

the

day

we

rece

ive

the

case

in la

b.

LOOKING FOR ADVICE?Consult our implant specialists on your

next case at [email protected] or

call 877-337-7800

IMP-0002 © 2018 DDS Lab. All rights reserved

ASK ABOUT OUR SURGICAL GUIDESUnlimited consultations and sites included in packages

CALL FOR $50 OFF FIRST CASE COUPON

877-337-7800 go.ddslab.com/implants

MyDDSLab.com | 877.337.7800

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YOU HAVE BEEN SIGNED UP FOR MyDDSLab.com,OUR COMPLIMENTARY ONLINE RX SYSTEM.Call for your login information today!

USE MyDDSLab.com TO...

• Submit prescriptions online

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• FedEx shipping management

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• NEW! Case tracking mobile app

MyDDSLab.com | 877.337.7800

MyDDSLab Mobile App

24 /7 CASE TRACKINGAND STATUS UPDATES

WHY DOWNLOAD THE MYDDSLAB APP?

• No need to take time out of your day to call your account manager

• Everything you need to know to track your case is right there under your fingertip

• Always know where your patient’s case is in the production process with color-coded,instant status updates:

REQUIREMENTS TO USE THE MYDDSLAB APP

Step 1: Sign up for our portal MyDDSLab.com

Step 2: Download our new mobile app to track your cases

C R OW N S | B R I D G E S | D E N T U R E S | PA R T I A L S | I M P L A N T S | O R T H O D O N T I C S

Your success is always our priority. With our support, your practice thrives. Whether you know exactly what you’re looking for, or you want advice on a complex case, we’ll put our experience to work for you.

TRUST OUR TEAM TO HELP YOU STAY FOCUSED ON WHAT YOU DO BEST: CARING FOR YOUR PATIENTS.

Call, email, or live chat with customer care

Direct connect with certified dental technicians and experienced techs in every specialty

Complex case? Receive case consultations and help with case planning from experienced techs who know the drill

Stay current. We are an approved continuing education program provider, offering live events across the country, as well as webinars and online courses.

PRACTICE TRUST

NEED ADVICE?We’re here when you need us.

Call, email, or live chat for help.

For more information and to send your first case in: go.ddslab.com/newdoc / 877.337.7800

PRACTICE QUALITY

C R OW N S | B R I D G E S | D E N T U R E S | PA R T I A L S | I M P L A N T S | O R T H O D O N T I C S

From our first conversation to final delivery, you can expect quality—meaning you experience fewer remakes and faster turnaround times on your restorations. How do we go above and beyond? Our six-point inspection process ensures your cases are accurate.

BITE

SHADE

ALIGNMENT

FIT

DESIGN

THICKNESS

For more information and to send your first case in: go.ddslab.com/newdoc / 877.337.7800

Crown & Bridge RxLaboratory Procedure Prescription

REQUIRED INFORMATION

CASE INSTRUCTIONS

RX SPECIFIC INSTRUCTIONS

Please CIRCLE single units and BRACKET splinted units

Please provide any photos, study models, diagnostic casts with caseEmail photos to: [email protected]

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Dentist signature** ________________________________________ (REQUIRED)

Dentist license no. _________________________________________ (REQUIRED)

Metal PFM

□ White HN*

□ Semi-precious

□ Non-precious

□ Yellow HN (for PFM)

□ Captek™

Full Cast□ Full cast Yellow HN gold

□ Full cast Yellow noble (2% AU)

□ Full cast White HN

□ Full cast Semi-precious

□ Full cast Non precious

□ Full cast Noble (AU 40%) D2970 - Medicaid

Zirconia / All Ceramic

□ Zirconia Solid (not recommeded for anterior)

□ Zirconia Layered

□ High Translucent (max 3 unit bridge)

□ Solid lingual with porcelain facial

□ IPS e.max® Press (max 3 unit bridge)

Other

□ Composite resin

□ Temporary (acrylic)

□ Temporary w/ metal

Return for

□ Die trim

□ Bisque

□ Metal try-in

□ Finish*

Restoration

□ Crown

□ Bridge

□ No-prep veneer

□ Veneer

□ Inlay/Onlay

□ Implant

□ Post & core

□ Diagnostic wax-up

□ Rest seats (specify) ______________

□ Crown under partial (specify) ______________

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

Tooth Shade _______________ Shade Guide Used _____________(REQUIRED) (vita is default)

Stump Shade _______________ Pink Tissue Shade _____________(REQUIRED FOR E.MAX)

If Insufficient Room

□ Trim opposing*

□ Call to discuss

□ Metal occlusal

□ Reduction coping

□ Metal island

Occlusal Contact

□ Light*□ Open

□ Tight

Interproximal Contact

□ Light*□ Medium

□ Heavy

CROWN DESIGN

Mod

ified

ri

dge-

lap

Sani

tary

/hy

gien

ic

Sadd

le

ridg

e-la

p

Con

ical

Ova

te

MARGIN DESIGN

Please circle your choice(s) of margin combination

Show No Metal 360o All Porcelain Shoulder 360o Metal Collar 360o Facial Porcelain Shoulder 180o Lingual Metal Collar _____ mm. Metal Occlusal Metal LingualShow No Metal 360o All Porcelain Shoulder 360o Metal Collar 360o Facial Porcelain Shoulder 180o Lingual Metal Collar _____ mm. Metal Occlusal Metal LingualShow No Metal 360o All Porcelain Shoulder 360o Metal Collar 360o Facial Porcelain Shoulder 180o Lingual Metal Collar _____ mm. Metal Occlusal Metal LingualShow No Metal 360o All Porcelain Shoulder 360o Metal Collar 360o Facial Porcelain Shoulder 180o Lingual Metal Collar _____ mm. Metal Occlusal Metal LingualShow No Metal 360o All Porcelain Shoulder 360o Metal Collar 360o Facial Porcelain Shoulder 180o Lingual Metal Collar _____ mm. Metal Occlusal Metal LingualShow No Metal 360o All Porcelain Shoulder 360o Metal Collar 360o Facial Porcelain Shoulder 180o Lingual Metal Collar _____ mm. Metal Occlusal Metal LingualShow No Metal 360o All Porcelain Shoulder 360o Metal Collar 360o Facial Porcelain Shoulder 180o Lingual Metal Collar _____ mm. Metal Occlusal Metal Lingual

Show no metal 360°*

All porcelain shoulder 360°

Metal collar 360°

Facial porcelain

shoulder 180°

Lingual metal collar(traditional)

Metal or Zirconia occlusal

Metal or Zirconia lingual

Characterizations Pontic Design

*

*

Doctor Name _____________________________________________ Last First

Practice Name ____________________________________________

Address _________________________________________________

Phone ___________________________________________________

Patient Name _____________________________________________

Patient Chart # ___________ □ M □ F DOB _________________

Rx Date ______________ Due Date/Delivery on _______________ (standard working time if no date given)

Case turnaround times are based on the date the Rx is received at DDS Lab. Please allow 10 business days (M-F) from that date and 13 business days for complex cases.

5440 Beaumont Center Blvd, Suite 400 | Tampa, Florida 33634877-337-7800 | www.DDSLab.com | DL 10334

**The person signing this form is an authorized signer and, along with the dental practice, accepts responsibility for payment of all related charges, as well as any legal costs, collection and other fees incurred by DDS Lab in the event the account is sent to collections or litigation. RX-CNB2017 © 2017 DDS Lab. All rights reserved.

*Standard design if an option is not selected



NIGHTGUARDS/SPLINTS OTHER


________________________________________________________

________________________________________________________




Practice Name ____________________________________________

Address _________________________________________________

Phone ___________________________________________________

Patient Name _____________________________________________



Case turnaround times are based on the date the Rx is received at DDS Lab. Please allow 10 business days (M-F) from that date and 13 business days for complex cases.




Removable Prosthetic RxLaboratory Procedure Prescription

□ Soft

□ Hard (clear acrylic)

□ FlexiGuard™ (hard-soft)

□ Astron thermoguard

□ Sports guard

□ dreamTAP® snore guard

□ Reline □ Rebase

□ Simple repair

□ Complex repair

□ Soft liner

□ Add clasp ______________ (CLASP TYPE)

PARTIALS

DENTURES

□ Upper

□ Lower

□ Both

□ Custom tray

□ Base plate

□ Bite rim

□ Set-up/Try-in*

□ Elite™ Denture*

□ Premier™ Denture (extra charge)

□ Immediate/Surgical Denture

□ Finish

□ Cast metal base

□ Metal mesh

□ Patient ID (extra charge)

□ Custom Tray □ Base Plate □ Bite Rim

Base Material (non-metal)

□ Acrylic Partial

□ CustomFlex™ Partial

□ Valplast® Partial

□ Immediate/Surgical partial

Metal Framework

□ Chrome Cobalt*□ Vitallium

□ Elite Acrylic Partial*□ CustomFlex™ Partial

□ Valplast Partial

□ Cast metal only

□ Cast metal w/ Set-up/Try-in

□ Cast metal w/ Bite rim

Tooth Type

□ Elite™* □ Premier™ (extra charge)

Partial Design

□ Horseshoe palate (upper)

□ Wrought wire clasps (2*)

□ Lingual apron (lower)

□ A-P strap

□ Unilateral (nesbit)

□ Ball clasps

Framework Design

□ Full palatal metal coverage (upper)

□ Lingual bar (lower)

□ Cosmetic clasp

□ Teeth to be extracted from model now

□ Teeth removed from model at final processing

Acrylic Shade (REQUIRED)

□ Lucitone 199* □ Light Meharry

□ Light Pink (Luc 199L) □ Meharry (Luc 199D)

Tooth shade _____________ Tooth Mould No. _________________(REQUIRED)

Shade Guide Used ____________________________ (Vita is default)

EXTRACTIONS

CASE DESIGN

Upper Arch Lower Arch

Upper Arch Lower Arch

12

16

32

31

17

1830 19

29 2028 21

2726 25 24 23

2215

3 144 135 12

6 117 108 9

12

16

32

31

17

1830 19

29 2028 21

2726 25 24 23

2215

3 144 135 12

6 117 108 9

Please MARK all teeth to be extracted and replaced

□ Follow the doctor’s design □ Best design for fit and function

□ Upper □ Lower □ Both □ Set-up/Try-in* □ Finish


FINAL ABUTMENT TYPE

CUSTOM ABUTMENT

SCREW RETAINED


Practice Name ____________________________________________

Address _________________________________________________

Phone ___________________________________________________

Patient Name _____________________________________________



Case turnaround times are based on the date the Rx is received at DDS Lab. Please allow 13 business days (M-F) from that date.

Posteriors □ Zirconia Solid

Anteriors □ Solid Lingual □ Facial Layered

Emergence Profile

□ Push tissue by 0.5mm □ Anatomical design

□ Ridge lap on buccal on screenshots

□ Follow tissue

(no expansion)

□ Contour design

(expand tissue by 0.5mm)

□ Anatomical (fully expand tissue)

To be included

□ Lab analog

□ Impression coping

□ Abutment

□ Others

□ Zirconia Solid Screw Retained Implant

□ Custom Titanium Abutment

□ Custom Zirconia Abutment

□ PFM Screw Retained

Implant

Type _________________________

Size __________________________

Design

□ L - 0.5mm

□ B - 1mm

□ D - 0.5mm

□ M - 0.5mm

Emergence Profile

CASE INSTRUCTIONS

MARGIN DESIGN

CROWN DESIGN

Please CIRCLE single units and BRACKET splinted units

Please circle your choice(s) of margin combination

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

Show no metal 360°

Show no metal 360°*

All porcelain shoulder 360°

Metal collar 360°

Facial porcelain

shoulder 180°

Lingual metal collar(Traditional)

Metal or Zirconia occlusal

Metal or Zirconia lingual

Lingual metal collar(Traditional)

Characterizations Tooth Shade (REQUIRED) ___________________

Pontic Design

If Insufficient Room

□ Trim opposing* □ Call □ Reduction coping

□ Metal occlusal □ Metal island

Occlusal Clearance □ Light* □ Open □ Tight

Contact □ Light* □ Medium □ Heavy

Metal□ White HN*

□ Semi-precious

□ Non-precious

Zirconia / All Ceramic□ Zirconia Solid

□ Zirconia Layered

□ IPS e.max

Restoration□ Crown □ Bridge

Return for□ Die trim

□ Bisque

□ Metal try-in

□ Finish*



________________________________________________________

________________________________________________________

________________________________________________________






Implants RxLaboratory Procedure Prescription

*


SPRING ALIGNERS FIXED APPLIANCES

ARCH DEVELOPMENT


□ Modified □ Super Modified

Extension with

□ Clasp □ Wire

□ Rest □ No reset

□ Reset teeth

Remove Provide□ Lingual □ Bands

Attachments □ Buccal

□ Buccal Tubes Tubes

U LFixed Anterior Bite Plate □ □Lingual Arch (Bilateral) □ □Nance □ □Habit Tongue Crib □ □Fence Tongue Guard □ □Band & Loop (Unilateral) □ □Active Loop □ □Sliding Loop □ □Looped Coil □ □Distal Shoe □ □Lip Bumper □ □Bluegrass □ □

U LHyrax RPE with Facemask hooks □ Hyrax RPE □ Bonded RPE □ Haas RPE □ Pendulum □ Pendex □ Quad-Helix □ □Bi-Helix □ □Transpalatal Arch (TPA) □ □“W” Expansion Appliance □ □ Schwartz □ □Sagittal □ □Crozat □ □Twin Block □ □E-Arch □

RETAINERS

□ Finished

□ Unfinished

□ Duplication

□ Upper

□ Hard

□ Flexi

□ Lower

□ Soft

□ Astron

Appliance Options □ Upper □ Lower □ Both

Bleaching Trays □ Soft □ 1.5mm

Essix/Invisible Retainers□ Full occlusal □ Scalloped □ Straight

Acrylic Design Options□ Anterior Bite Plate □ Posterior Bite Plate

□ Reverse Incline Bite Plate □ Horseshoe Palate

□ Scalloped Anteriors □ Facial Acrylic on Labial Bow

Retainer Type□ Hawley □ Flipper + 1 Pontic

□ Wraparound □ 3x3 bonded retainer

□ Wraparound without □ QCM stabilizing wires

Acrylic Color □ Pink* □ Clear □ #____

Labial Wire□ 3-3* □ 2-2 □ 4-4 □ Flat labial bow

Clasps□ Ball* □ C □ Arrow □ Adams

□ Soldered C □ Soldered Adams □ Occlusal Rest

R

Pontic 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

Shade

L


________________________________________________________

________________________________________________________




Practice Name ____________________________________________

Address _________________________________________________

Phone ___________________________________________________

Patient Name _____________________________________________



Case turnaround times are based on the date the Rx is received at DDS Lab. Please allow 10 business days (M-F) from that date. Allow 13 business days for complex cases.




Orthodontic Appliance RxLaboratory Procedure Prescription

3 2 1 1 2 33 2 1 1 2 3

R L

Auxiliaries□ Finger Springs □ Spring Helixes

□ Z Spring □ Molar Retracting Spring

□ Stabilizing Wires □ Bloore Spring

□ Mushroom Spring

STUDY MODELS NIGHTGUARDS

Terms and Conditions

1. Payment is due in full upon receipt of the appliances or services.2. DDS Lab in its sole discretion can require all accounts to be COD until a credit application is completed, reviewed and approved.3. Past due accounts shall bear an interest rate of 1.5% per month or maximum allowed by law, until the balance is paid in full.4. DDS Lab may refuse to accept new or complete existing orders on accounts with past due balances.5. Accounts more than sixty (60) days past due will be subject to COD including any COD surcharge until the account is current. DDS Lab may require a delinquent account holder to pay a deposit for existing or continuing orders.6. DDS Lab reserves the right to refuse to accept orders and/or terminate the agreement without notice. Following any termination, customer agrees to pay all outstanding balances, plus any reasonable attorney’s fees and costs associated with collecting the balance or monies owed.7. Any credit must be applied to appliances and services within sixty (60) days of issuance.8. Returned checks will be assessed the maximum fee permitted by law plus any associated bank costs/fees.9. Customer must examine all goods and appliances for fitness and condition. Please see Limited Warranty/Limitation of Liability policy.10. Any use, sale, alteration or modification to the appliance or failure to timely notify and return the appliance to DDS Lab within thirty (30) days of receipt of the item shall constitute acceptance of the appliance. 11. DDS Lab reserves the right to cure or correct any defect before issuance of any credit or refund.12. Hi-Noble and full cast product prices are valid for gold at not more than $1500 per troy ounce. For every incremental change of $100 in the price of gold (subject to a minimum price of $1500 per troy ounce) it may become necessary to increase the price of Hi-Noble and PFMs by up to $15 per unit (with metal occlusal $20 per unit) and Hi-Noble full cast restorations by up to $25 per unit. Any adjustment to our prices will be communicated two weeks in advance of the change.13. Each laboratory authorization procedure (prescription) constitutes a complete and separate transaction billed and collected.14. The laws of the State of Florida will govern this transaction, and venue shall be in Hillsborough County, Florida.

Remake Policy Remake charges of 50-100% will apply under the following conditions:

1. If a remake is requested after the lab deemed the provided case materials incomplete and/or unsatisfactory and customer elects to proceed with the completion of the case without making any adjustment, refuses a try-in, or does not supply requested materials.2. If a remake is requested because the customer requests a tooth shade or mould different from the original request. 3. If a remake is requested due to treatment plan or material change from the original request.4. If a remake is requested greater than 30 days from invoice date.5. If a remake is requested for immediate/surgical partials or dentures or treatments with healing extractions.6. If a remake is requested because the appliance fits the model, but does not fit in the mouth. 7. If a remake is requested and the remake reason is not specified, original materials or appliance(s) are not returned.

DDS Lab’s Remake Policy will not apply to any account past due. DDS reserves the right in its sole discretion to refuse accepting any new cases and processing remake cases until the balance is paid in full and the account is current.

A non-refundable charge will apply if the original appliance is not returned at the time of remake request.

DDS Lab can amend the remake policy at its sole discretion and without prior notice.

About Your Lab Work

Dental restorations are manufactured and/or distributed by DDS Lab, LLC, 5440 Beaumont Center Blvd, Suite 400, Tampa, FL 33634. DDS Lab is a full-service dental laboratory with the following memberships and certifications: NBC Certified Dental Laboratory (CDL #123252-00), FDA registered (FDA #3004632064, 3009687180, 3009319807) and National Association of Dental Labs (NADL #122122-0). For additional details, please refer to the accompanying list of materials and the corresponding point of origin for materials disclosure on the front of this invoice.

Limited Warranty/Limitation of Liability

DDS Lab warrants that all crown and bridge restorations and removable prosthetics, and other devices will be constructed according to the prescribing dentist’s specifications.

DDS Lab will repair or replace any product that fails due to defects in materials or workmanship, such as chipped or cracked porcelain, broken acrylic and/or a tooth falling out of removable appliance, within a period of one year from date of invoice.*

The warranty will be void for removable prosthetics fabricated without a try-in/setup.

DDS Lab is not responsible for any additional costs or fees associated with adjustments, repairs and replacement of dental devices.

DDS Lab does not warrant that such devices are fit for any particular purpose and if such disclaimer is not permitted by law, the duration of any implied warranty is limited to ninety (90) days from the date of delivery.

This warranty is in lieu of and supersedes all other warranties, whether expressed or implied, and may not be modified by any agent, employee, representative or distributor of DDS Lab.

*Orthodontic appliances are warrantied for a period of 90 days from date of invoice.

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Turnaround time is measured in business days and measurements begin when the case is received at DDS Lab Tampa and end when the case is delivered to the customer. These dates do not include the shipping time from your office to the lab. Extended turnaround times due to Chinese New Year.

SCHEDULING CALENDAR 2019STANDARD FIXED, REMOVABLE

AND ORTHODONTIC CASESIMPLANT, COMPLEX* AND

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www.ddslab.com // 877.337.7800

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*COMPLEX = 6 OR MORE UNITS IN ONE CASE **COMBINATION = 2 OR MORE PRODUCTS IN ONE CASE; FIXED, REMOVABLE, IMPLANT

SEND DIGITAL MODELESS AND REDUCE TURNAROUND TIME BY 5 OR MORE BUSINESS DAYS.3-DAY RUSH TAT FOR ZIRCONIA SOLID & ZIRCONIA HT (UP TO 3 UNITS) = $50 MORE PER UNIT; PLEASE WRITE “3-DAY RUSH” IN NOTES ON RX FORM.

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Rush cases need to be prescheduled and may carry a premium rush fee. DDS Lab cannot commit to a return date until we have received the case in lab.

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SCHEDULING CALENDAR 2019STANDARD FIXED, REMOVABLE

AND ORTHODONTIC CASESIMPLANT, COMPLEX* AND

COMBINATION** CASES

www.ddslab.com // 877.337.7800

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SEND DIGITAL MODELESS AND REDUCE TURNAROUND TIME BY 5 OR MORE BUSINESS DAYS.3-DAY RUSH TAT FOR ZIRCONIA SOLID & ZIRCONIA HT (UP TO 3 UNITS) = $50 MORE PER UNIT; PLEASE WRITE “3-DAY RUSH” IN NOTES ON RX FORM.

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