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Prosthetic Rx Form

Use the form below to submit your case details quickly and accurately. This prescription form helps us craft high-quality dental restorations tailored to your patient's needs. Simply fill out the necessary information, select your preferred materials and specifications, and submit your order. Our team at Ceramic Arts Dental is committed to precision and excellence in every case we handle.

Fixed Prosthetics Rx

Finished Date Requested
Month
Day
Year
Impression Type
Restoration
Material Options
Implant Abutments
Implant Options
Shade Options
Would you like a Scan Model?
Yes
No
Enclosed Checklist
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