DED LAB Case Pick Up

DED PICK UP REQUEST FORM

A driver will be there soon !!!
IMPORTANT MESSAGE. NO SAME or NEXT DAY REPAIRS March 4th, 5th and 6th

deliveries and pick up will be normal
Dental Office:
Name of Dental Practice
Doctor's name:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Phone Number
Please enter a valid phone number.
Pick up Date & Time*
PLEASE CHOOSE PICK UP DEPARTMENT*
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REMOVABLE DEPARTMENT
Dentures, Partial Dentures, Custom Trays, Bite Block, Set ups, Finish and process, Flexible Partials and metal frames too.

$ Free Quantity



Crown and Bridge Department
PFM, PFZ, Full Zirconia , Full Cast Crowns,

$ Free Quantity



SAME DAY RAPAIR or Relines
Same Day Service Request

IMPORTANT NO SAME DAY OR NEXT DAY REPAIR

WEdnesday Thursday and Friday of this week.

March 4,5,6. All Repairs will be for Monday 9th.

$ Free Quantity



Total

$0.00
Dr. Notes
Example. Need Bags
RX picture (Important)

send us a picture of the case. We receive hundreds of cases. keeping a digital copy will be better for your records and ours.
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Case Picture

Send us a picture of the case. We want to make sure our driver bring exactly what you packed for us.
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Should be Empty:

DED PICK UP REQUEST FORM