Zirconia Lab Ticket
Please complete all the sections as fully as possible
Dentist's Name
*
Dentist's e mail
*
(for any queries to be addressed to)
Patient's Name
*
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Please select required item from list below:-
Please Select
Zirconia Copings
Full Monolithic
Zirconia Coping Vived ST. 1100mpa
CAD Cast (Inc Mill & Finish)
Wax
PMA Mono Block
PMA Multi Layer/ Composite
Digital Models
Valpast Flexible Dentures
Dentures
Vitallium Chrome Cobalts
Chromes
Zirconia Copings
HT Zirconia Coping
HT Zirconia Coping Bridge Unit
Full Monolithic
Zircolite Zirconia Crown
Zircolite Zirconia Bridge
Zircolite Multi Layer Crown
Zircolite Multi Layer Bridge
Please stipulate:-
Weather Sintered Only
Glaze & Finish
Zirconia Coping Vived St. 1100mpa
Zircolite Zirconia Crown
Zircolite Zirconia Bridge
Zircolite Multi Layer Crown
TZircolite Multi Layer Bridge
CAD Cast (inc Mill + Finish)
Crown Coping
Bridge Framework
Wax
Coping & Bridge
Full Morphology
PMA Mono Block
Single
Bridge
PMA Multi Layer/ Composite
Single
Bridge
Composite Crown/Inlay (bre-cam)
Digital Models
Sectional Articulated Up 14 pins
Sectional Non-Articulated Up 14 pins
Quadrant Up to Full Arch
Removable Dies for the Above
Valplast Flexible Dentures
Partial Flexi Process only
Partial Flexi Fully Processed
Flexi Partial Reline
Addition of Tooth (per case)
Addition of Teeth (per case)
Flexi Dental Cleaner (12 month supply)
Dentures
Acrylic
Flash/ Pack/ Finish
Vitallium Chrome Cobalts
Full Upper Lower Chrome
Plate Type Chrome
Skeletal Design Chrome
Acetal Clasps
Solvay Ultaire (Mill Only)
Solvay Ultaire (Design & MIll)
Zirlux Partial (Milling Only)
Chromes
Upper/Lower Chrome
Plate Type Upper/Lower
Skeletal Design Chrome
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Vita Shade
Case Instructions
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Required Delivery Date
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Day
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Month
Year
Note: Dates for delivery of the work into the surgery
Type a question
1st Class
Courier
Special Delivery
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