PDS Online Lab Sheet
Crowns & Bridges
Customer Details
Dentist Name
Practice Name
Customer Email
example@example.com
Patient Name
Customer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Order Date
-
Day
-
Month
Year
Date
Request Date
-
Day
-
Month
Year
*For PVS impression case, the turnaround time could take up to 2.5 to 3 weeks
Tooth Number
11
12
13
14
15
16
17
18
21
22
23
24
25
26
27
28
31
32
33
34
35
36
37
38
41
42
43
44
45
46
47
48
Restoration type
*
Please Select
Full ( Monolithic ) Zirconia Screw Retain Implant Crown
Zirconia with High Translucency Screw Retain Implant Crown
Layered Zirconia ( PFZ for Aesthetic zone ) Screw Retain Implant Crown
PFM Screw Retain Implant Crown
Full ( Monolithic ) Zirconia
Zirconia with High Translucency
Layered Zirconia ( PFZ for Aesthetic zone )
PMMA ( Temporary crown )
PFM ( Porcelain Fuzed Metal )
Gold Crown
E-Max
Occlusal Splint ( Night Guard )
Flexi Denture
Essix Type Clear Retainer
Abtument type
Please Select
Screw retained custom abutment
Cement retained custom abtument
Hex bridge with screw access hole
Non-hex bridge with screw access hole
Implant manufacturer
Implant model
Implant size
Scan body used
Interproximal Contact
Normal
Extended
Pontic Design
Ovate
Conical
Ridge Lab
Hygienic
Modified
Occlusal Contact
Open
Heavy
Light
Desired Shade
*
Material Enclosed
Impression
Stone Model
Oral scan file(STL)
ETC
How to ship material
Request for courier pick up (Please securely place the materials inside the sturdy parcel box and have it prepared at the reception desk for us to pick up)
Upload - Here / Medit
Email to digitallabpds@gmail.com
Wetransfer to digitallabpds@gmail.com
File Upload(STL file upload here)
File Upload
Drag and drop files here
Choose a file
STL file upload here
Cancel
of
File Upload ( Shade or X-ray images as reference. e.g. Shape of Emergence Profile )
File Upload
Drag and drop files here
Choose a file
( Shade or X-ray images as reference. e.g. Shape of Emergence Profile )
Cancel
of
Additional Instruction
Submit
Should be Empty: