Post on 15-Jul-2020
843 Quince Orchard Blvd. Ste C&DGaithersburg MD, 20878Ph: 240.912.9670info@lintecdental.comwww.lintecdental.com
Doctor’s Name:AddressPhone # Acct #Email Address
Patient’s Name:Age Female MaleDeliver by 5 p.m. on Review Time:
Enclosed with case:Impressions Models Bite Photos Other:
Denture
Removable Partial Dentures
Splints/Nightguards
Repair
Ivoclar DCL DentureCAD/CAM DentureImmediate Denture
Doctor’s Name: Signature License #:
Custom TrayOcclusion RimWax setup try-inFinish
SLA metal frameValplastFlipperUltaire AKP
Frame try-inFrame w/occlus. RimFrame w/setup try-inFinish
Hard Soft Hard & Soft
Reline Breaks/Cracks
Add Clasp Add Tooth Add Retention
Minor ConnectorMaxillary Mandibular Clasp Options Tooth #
Rest Areas Tooth #
Lab Select Lab Select Lab SelectMetal
Lab Select Lab Select EsthetiClasp Thermoflex
Removable
Additional Notes
SHADE