PDP Lab Slip

Dental Precision Prosthetics Inc.
23439 N. 35th Drive

Suite 2

Glendale, AZ.

85310

602.485.7845

precisiondentalpros@gmail.com

precisiondentalpros.com
Date Wanted*

MonthDayYear
Date
Patient Scheduled

MonthDayYear
Date
Hour MinutesAM/PM Option
Doctor*
or Office Name
Phone*
Email*
example@example.com
Address

Street Address

CityState

Zip Code
Patient*
Patient

Sex:MF
Age
Phone Consultation

YesNo
Dentist Signature

Clear
License #
Included with Case

ImpressionsMaster ModelOpposing ModelStudy ModelTeethBite RegistrationArticulatorDr's Set-upPhotosOther
Shade*
Vita Shades Work Best (type NA if not needed)
Choosing "Match Shade" as your shade selection releases PDP of any costs due to shade selection. If a new shade is chosen the replacement of the teeth will be at full cost to your account.
Maxillary Tooth Selection *

NAFull Denture / All Teeth23456789101112131415
Mandibular Tooth Selection*

NAFull Denture / All Teeth1819202122232425262728293031
Youtube
High Lip Line
Low Lip Line
Facial Meter

SmallMediumLarge
Youtube
Youtube

Denture Gauge Measurements

	Upper	Lower
Vertical (V)
Horizontal (H)

Dental Precision Prosthetics Inc.