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Note: Dear Doctor ,please print and fill up the following for for the best of our future colaboration.
| Doctor: | | Address: | | | Phone: | | City/Prov: | | | Fax: | | E-mail: | | | Operating Hours: | |
| Contacts: | Broad Point Normal Tight Light | | Occlusal Contact With Opposing Teeth? | | Positive Contact | | | Foil Relief | | | Out of Occlusion | |
Past Problems with Other Labs ? |
| Shade | | Contacts | | Margins | | | Occlusion | | Fit | | Contour | | | Service | | Other | |
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