DED LAB Case Pick Up

DED PICK UP REQUEST FORM

A driver will be there soon !!!
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.Format: (000) 000-0000.
Pick up Date & Time*
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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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

$ Free Quantity



Total

$0.00
Should be Empty:

DED PICK UP REQUEST FORM