OSSTEM DIGITAL CENTRE
Suite4.19, 32 Delhi Road,
Macquarie Park, NSW 2113
digitalcentre@osstem.com.au
(02) 98892675 (Press #3)
0427062444
OSSEM DIGITAL CENTRE ORDER SHEET
Customer Details
Dentist Name
Practice Name
Customer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Customer Email
example@example.com
Order Date
Please select a day
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Day
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January
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Month
Please select a year
2030
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Year
Request Date
-
월
-
일
년
DATE
Patient Name
Tooth Number
*
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Type of Restoration
Please Select
Crown and Bridge
Cement retained prosthesis
Screw retained prosthesis(if possible)
Temporary Crown
Inlay/Onlay
Clear splint(Flat plane Hard)
Digital diagnostic Wax-up
Radiographic template
Type of Abutment
Please Select
Onefit Abutment(Premilled custom)
Ti-base Link Abutment
Stock Abutement
Material of Restoration
Please Select
Zirconia
EMAX(CAD)
PMMA(Temporary)
PFM
Full Gold
Interproximal Contact
Normal
Extended
Pontic Design
Ridge Lap
Modified
Conical
Hygienic
Ovate
Occlusal Contact
Light
Open
Heavy
Desired Shade
Material Enclosed
*
Impression
Stone Model
Oral scan file(STL)
ETC
How to ship material
*
Courier
post
Upload
Partner link
Other
Partner link
Please Select
3 Shape Communicate
Itero
Medit Link
Dentsply Sirona
Other
File Upload(STL file upload here)
Browse Files
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