For all anterior cases please provide the following items and mark they have been sent

Pre-Op Model Wax Presentation Model or Model of Temps Stick Bite Face Bow Measurement of Central Underlying Tooth Color (prep shade) Photos for Shade

For all anterior cases please provide the following items and mark they have been sent

Pre-Op Model Wax Presentation Model or Model of Temps Stick Bite Face Bow Measurement of Central Underlying Tooth Color (prep shade) Photos for Shade

Pictures: john@treasuredental.com

___ Porcelain-to-metal

___ Porc. Butt Margin

SHADEGingival Shade: _______________

Body Shade: _________________

Incisal Shade: ________________

Prepped Tooth Shade: __________

(All-Porcelain & Lava™)

___ Gold Crown

___ Gold Inlay/Onlay___ IPS e.max___ IPS Empress___ Authentic___ Refractory

be placed on COD including outstanding balance due with shipment of case. Dentist will be responsible for all collection costs, including attorney’s fee to collect past due balance. By signing below you are legally obligated to these terms.

S-0312

PORCELAIN TO METALALL PORCELAINVENEERS

GOLD

(Our standard is no collar)___ No Collar___ Small Lingual Collar___ Small Lingual & Buccal Collar___ Metal Lingual/Metal Occlusal

ALLOYS-CERAMIC

METAL DESIGN

___ IPS e.max___ Lava™ CZR Press___ Sinfony

FULL CROWN/BRIDGE

INLAY/ONLAY

PONTIC DESIGN

ALLOYS FOR GOLD WORKHigh Nobel Yellow Gold 89.5%

High Nobel (High Nobel 62)

Predominately Base (Tilite)

For all anterior cases please provide the following items and mark they ha

Pre-Op Model Wax Presentation Model or Model of Temps Stick Bite Measurement of Central Underlying Tooth Color (prep shade) Photos f

TREASUREDental Lab

3735 Washington ParkwayIdaho Falls, ID 83404

(208) 524-1888 (800) 325-5244Fax (208) 528-5443treasuredental.com

___ Lava™ Hand Stack___ Lava™ CZR Press

___ Zirkonzahn Full Zirconia___ Authentic___ Empress___ IPS e.max (Crown)

For all anterior cases please provide the following items and mark they have been sent

Pre-Op Model Wax Presentation Model or Model of Temps Stick Bite Face Bow Measurement of Central Underlying Tooth Color (prep shade) Photos for Shade

High Nobel 60% Yellow Gold

High Nobel White Gold

High Nobel Inlay/Onlay 77%

For all anterior cases please provide the following items and mark they ha

Pre-Op Model Wax Presentation Model or Model of Temps Stick Bite Measurement of Central Underlying Tooth Color (prep shade) Photos f

For all anterior cases please provide the following items and mark they ha

Pre-Op Model Wax Presentation Model or Model of Temps Stick Bite Measurement of Central Underlying Tooth Color (prep shade) Photos f

___ Porcelain Butt Margin

Nobel Y+ Yellow/Rose