Customer Forms

Dentist Preferences

Please complete the form below detailing your restorative preferences. If there are multiple providers, please have each provider complete a Dentist Preference Form. This information is vital to assure minimal adjustments chair-side. Thank you.

Contact Information

Practice Name

Name *

First

Last

Specialty

Dentist NPI #

Cell Phone

Email *

This should be the best email address for to communicate directly with you

Crown & Bridge Contacts

Digital Die Spacer

None
Light
Medium*
Heavy

Items with asterisk are recommended

Occlusal Contacts

Tight
Light
Out of Occlusion

Adding a pre-op scan to your case can show us where their bite was before.

Occlusion appears to be off on the scan

Design from pre-op scan
Attempt to manually adjust then verify with me
I would prefer to re-scan the patient

If our technician does not feel the bite is accurate, how should we proceed?

Occlusion has insufficient reduction

Call me to discuss
Adjust opposing tooth
Adjust the prep and mark model / die
Adjust the prep and make a 3D printed reduction coping (extra cost)

If we need more occlusal clearance, how should we proceed?

Interproximal Contacts

What strength and shape do you like your interproximal contacts? You can select more than one.

Stain and Glaze Preferences

Occlusal Staining

None
Light
Medium*
Heavy

Color will be specific to the shade of the restoration. One with asterisk is recommended to look the most natural.

Gingival Staining

None
Light*
Medium
Heavy

Color will be specific to the shade of the restoration. One with asterisk is recommended to look the most natural.

Do you have any special instructions for our ceramicist?

Implant Preferences

Implant preferences are general parameters. We will contact your office if there is any reason we could not use your preferences.

Do you prefer Screw Retained or Cement Retained?

Screw Retained
Cement Retained

Screw Retained is most requested with the increased strength and esthetics of the new generation zirconias.

For custom abutments, do your prefer to have the margin above or below the tissue?

Above the Tissue
Below the Tissue

Typically below the tissue, but we can place it where you would like.

What materials do you prefer in the anterior?

High-Esthetic Zirconia
High-Strength Zirconia
Pressed eMax

We do not offer PFM restorations.

What materials do you prefer in the posterior?

High-Esthetic Zirconia
High-Strength Zirconia
Pressed eMax

We do not offer PFM restorations.

How do you handle tissue management?

Stock Healing
Custom Healing
Tissue Former
None

Are you using any provisionals to control tissue contours?

New Dentist Form

New Dentist Form (continued)

Dentist Preferences

Contact Information

Crown & Bridge Contacts

Stain and Glaze Preferences

Implant Preferences

Dentist Referral

Your Information

Referral Information

Case Feedback

Implant Feedback

New Product Survey

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