Contact
Contact
Personal application form
Commercial application form
Order form
*
It is obligatory to fill in these fields.
Dental practice stamp:
Patient :
*
E-mail:
Type :
Order no.:
Age:
Fissure stain:
Colour of teeth:
Order instructions including details of all facings
Please click the appropriate number in order to select it.
18
17
16
15
14
13
12
11
48
47
46
45
44
43
42
41
21
22
23
24
25
26
27
28
31
32
33
34
35
36
37
38
Comments:
Appointments:
Functional impression
Base plate
Primary crowns
Frame fitting
Raw/initial firing
1st wax setup
2nd wax setup
Alloy:
BioGold
High-percentage precious metal
Reduced-percentage precious metal
Non-precious metal
Model constructions:
total facing
lingual metal border
3/4 metal masticating surface
metal masticating surface
metal border
porcelain shoulder
Bridge span structuring:
Delivery appointment/completion:
Consultation
Impression-Taking:
Cast models:
Bite:
Other:
