RX Forms
Choose the tier that best fits your patient's needs, case-by-case.
Fill out RX forms online and print them out instantly. (Recommended)
Classic
Suggested for most cases
$
37
/unit
-
3-Year Warranty (Crown & Bridge)
-
1-Year Warranty (Removables)
-
8-12 business days turnaround (Determined by type of restoration)
Download Rx
Classic - Rx Form
Price listed above: Full-Contour Zirconia (Crown & Bridge; Classic tier)
Request full price list here
Price listed above: Full-Contour Zirconia (Crown & Bridge; Classic tier)
Request full price list here
Plus
Suggested for complex cases
$
49
/unit
-
5-Year Warranty (Crown & Bridge)
-
2-Year Warranty (Removables)
-
8-12 business days turnaround (Determined by type of restoration)
Download Rx
Plus - Rx Form
Price listed above: Full-Contour Zirconia (Crown & Bridge; Plus tier)
Request full price list here
Price listed above: Full-Contour Zirconia (Crown & Bridge; Plus tier)
Request full price list here
Most Popular
Elite
Suggested for urgent cases
$
89
/unit
-
5-Year Warranty (Crown & Bridge)
-
2-Year Warranty (Removables)
-
From 5 business days turnaround (Guaranteed)
Download Rx
Elite - Rx Form
Price listed above: Full-Contour Zirconia (Crown & Bridge; Elite tier)
Request full price list here
Price listed above: Full-Contour Zirconia (Crown & Bridge; Elite tier)
Request full price list here
ATTENTION: Typing is recommended. Any incomplete or illegible Rx forms will delay the case.
