Dr. Preference Sheet
Provide your preferences for streamlined case communication and service.
Doctor Information
Full Doctor Name
*
First Name
Last Name
Doctor License #
*
Practice Name
*
Practice Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Doctor Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferences
CONTACTS
Light
Medium
Heavy
Broad
Natural
CLEARANCE ISSUES
Trim Opposing
Reduction Coping
Change material, if possible, to avoid reduction
Call for instructions
POSTERIOR OCCLUSION
In Occlusion
Slightly Out of Occlusion
Out of Occlusion
ANTERIOR OCCLUSION
In Occlusion
Slightly Out of Occlusion
Out of Occlusion
ARTICULATION PREFERENCES FOR HARD MOUNTED CASES ONLY
Metal Hing Articulator
Denar
Stratos
Panadent
Mark 320
Sam
With whom should we contact regarding Delivery Dates, if Needed?
Office Staff
Doctor Only
Other
With whom should we contact for Technical Related Questions
Doctor Only
Assistant
Please provide contact name, (other than the Doctor) with whom we can discuss Technical Questions with?
Preferred Communication Method
Call Cell Phone
Text Cell Phone
Call Office
Email
No Preference
Submit Preference Sheet
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