Send Your Cases

Fill out the form to send your case in electronically, or download and print the lab slip below.

Mail lab slip, physical models, impressions, etc to:
Digital Dental Fusion
7945 W. Sahara Ave Suite 107
Las Vegas, NV 89117

(800) 931-1554
(725) 735-8099

Download Lab Slip

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

Dr. Name/Practice

Email

Address

Phone

Patient Name

Case #

Due Date

Redo

Previous Case #

FIXED SOLUTIONS:
POLYPEEK™®

Upper Lower PMMA Try In Final

FIXED SOLUTIONS:
ZIRPEEK®

Upper Lower PMMA Try In Final

FIXED SOLUTIONS:
ZIRTIBAR™®

Upper Lower PMMA Try In Final

SHADE #

GUM SHADE

ENCLOSED

Photo(s) Model Impression Bite Analogs Screws

Other

Implant Brand

Rx

Dr. Electronic Signature

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

License #

File Upload

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