Partner
Name
*
Email
*
Name of Dental Practice
Preferred Denture Type
Please Select
Traditional Denture
Digital 3D Printed Denture
Digital Milled Denture
Denture Stippling
*
Please Select
Yes - from 2nd bicuspid to 2nd bicuspid (ROE Standard)
No
Denture Festooning
*
Please Select
Yes (ROE Standard)
No
Post Dam
Please Select
Yes on analog. No on Digital
No on analog. Yes on Digital
Yes on both analog and digital
No on both analog or digital
Base and Rims
*
Please Select
Light Cured Base
SR Ivocap® processed base
Printed denture base (ROE Standard)
Denture Teeth
*
Please Select
Premium (ROE Standard)
Economy
Set-Ups
*
Please Select
Ideal
Characterized
Follow Study Model
Border Preferences
*
Please Select
Full borders
2-3 mm borders
Other
Border Preference - enter in no. of mm
Occlusion
*
Please Select
Allow opening of the bite up to 2 mm (ROE Standard)
Always email/call/text the office
Patient Name on Denture
*
Please Select
Yes (ROE Standard)
No
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