The Measure of Excellence in Dental Prosthetics

Doctor Preference Form

General Information
  * Required Field
Office Hours
to Closed
to Closed
to Closed
to Closed
to Closed
to Closed
to Closed
Office Contacts For



Method of Payment COD Statement 20 Days Credit Card



Doctor Preferences

Non-precious
White high noble
Semi-precious
Yellow high noble



Non-precious (white)
Non-precious (yellow)
Semi-precious (white)
Full-cast gold (yellow)



Normal
Broad
Light
Heavy



Light
Normal
Foiled
Out of Occlusion



None
Light
Medium
See Pictures



Chamfer
Feather
Shoulder
Beveled Shoulder



Call Doctor
Reduce Prep
Send Reduction Coping
Relieve Opposing
Metal Occlusal



Yes
No



Ridge Lap
Modified Ridge Lap
No Ridge
Point Contact
High Water (Sanitary)



Smooth
Moderate
Heavy



Low
Moderate
Heavy



Post/core as unit
Core as separate unit

Removables

Yes
No



Vacuum Formed
Light-cured



Ivoclar
Mondial
Bioform
Bioblend
Portrait
Value



0°
10°
20°
33°



Plastic
Porcelain



Butterfly
Bead
Heavy
Normal



Rugae
Stipple
Gingival Anatomy
Personal Identification
Gingival Staining

Partial Frameworks

(Vitallium® 2000 & Economy)



Modify design as required
Reduce opposing teeth as required



Horseshoe
Palatal Strap
Lingual Bar
Lingual Plate
Kennedy Bar
Double Bar, Anterior/Posterior



Clasp as survey indicates
Circumferential
T-Roach Clasp
RPI Bar
E-Type Clasp
Akers

Additional Comments or Instructions
  
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