lab support

PATIENT NAME * Required ^*

DATE * Required ^*

SELECT THE LAB Required ^*

NAME OF THE CLINIC/ HOSPITAL * Required ^*

NAME OF DOCTOR * Required ^*

Address * Required ^*

TYPE OF WORK Required ^*

SINGLE IMPLANT CASE Required ^*

MULTIPLE IMPLANT CASE Required ^*

FULL ARCH CASE Required ^*

IMPLANT BRAND USED/TO BE USED Required ^*

IMPRESSION TYPE Required ^*

LAB ANALOG WILL BE PROVIDED BY Required ^*

JIG TRIAL REQUIRED Required ^*

TYPE OF ATTACHMENT Required ^*

RESTORATION TYPE Required ^*

ABUTMENT TYPE Required ^*

STOCK ABUTMENT TO BE PROVIDED BY Required ^*

CHOOSE THE ABUTMENT Required ^*

MENTION TOOTH NUMBER Required ^*

TOOTH SHADE Required ^*

GINGIVAL SHADE Required ^*

WORK STEP Required ^*

SENT ON Required ^*

Pickup Pincode Required ^*

COURIER PACKAGE INCLUDES

UPPER IMPRESSION LOWER IMPRESSION UPPER MODEL LOWER MODEL LAB ANALOG IMPRESSION POST ABUTMENT WAX BITE

REQUEST PICKUP DATE & TIME

Required ^*

Dentalaid