Send Your Cases

Fill out the form to send your case in electronically or download a lab slip.

Mail physical models and photos to:
Digital Dental Fusion
6280 S. Valley View Blvd.
Suite 310
Las Vegas, NV 89118

(800) 931-1554

Download Lab Slip

*Allow for 3 weeks case delivery after all necessary information is received.

Dr. Name/Practice

Address

Phone

Patient Name

Case #

Due Date

Redo

Previous Case #

FIXED SOLUTIONS:
ZIRPEEK®

Upper Lower PMMA Try In Final

FIXED SOLUTIONS:
POLYPEEK™®

Upper Lower PMMA Try In Final

FIXED SOLUTIONS:
ZIRTIBAR™®

Upper Lower PMMA Try In Final

REMOVABLE RESTORATIONS

DigiSmile® Dentures DigiSmile® Partials Upper Lower

ZIMO® CROWNS/BRIDGES

Zimo® Full Zirconia Zimo® + PFZ Zimo® + Veneer Zimo® Custom Abutment Zimo® Implant Screw Retained PMMA Try In

SHADE #

GUM SHADE

ENCLOUSURES

Photo(s) Model Impression Bite

Dr. Electronic Signature

Checking this box and submitting this form is recognized as an electronic consent that you are acknowledging all the information is accurate and Digital Dental Fusion will begin the case.

License #

File Upload