Send a Case Please use this form only for submitting Photos, RXs, and Videos.To send us a DICOM directly, request DropBox link here. Step 1 of 5 20% Step 1: Complete your Contact InfoDr. Name* Dr. Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dr. Phone Number*Dr. Email Address* Step 2: Lab Rx What type of RX are you submitting?*Please selectRemovableDigital DentureFixedYour RXAO4: Pre-Op/ProvisionalAO4: Conventional Final Step 1/PMRAO4: Conventional Final Step 2/Bar Try-InAO4: Zirconia Final Step 1/PMRAO4: Zirconia Final Step 2/Teeth and Wax Try-InAO4: Zirconia Final Step 3/Bar with Crowns Try-InAO4: Swiss Loc Final Step 1/PMRAO4: Swiss Loc Final Step 2/ Wax Try-inAO4: Swiss Loc: Final Step 3/ Bar Try-inAO4: Swiss Loc: Final Step 4/ Super StructureClick here to access all of our RX forms. Upload your LabRX Drop files here or Select files Max. file size: 256 MB. How are you sending the case?Please SelectLocal Pick-up (Greater Phoenix Area)Shipping Label (Outside Phoenix Metro)Digital Submission (IOS)Is this a wet pickup required? Yes No Date MM slash DD slash YYYY Time8:00am9:00amThird ChoicePlease make sure to wrap, keep moist, and refrigerate in a sealed zip-lock bag. We will pick up as soon as possible. Upload RecordsWhat type of file do you have to upload?* Photo Video Upload the records* Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, stl, dcm, zip, Max. file size: 256 MB. Upload RecordsWould you like to provide any special instructions? Δ
