Account Info & Doctor Preferences Practice Name * Practice Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Practice Website http:// Select Practice Type * GP Prosthodontist Periodontist Cosmetics Other Doctor's Name * First Name Last Name Doctor's Email * Doctor's Mobile Phone (###) ### #### Schedule Questions: Contact Name * Key contact for lab case communication First Name Last Name Office Manager's Name First Name Last Name Office Hours * Days Practice is open Monday Tuesday Wednesday Thursday Friday Saturday Preferred Payment Method * Credit Card Check COD Intra-oral Scanner * Yes No Crown Occlusion Preference * Single unit crown occlusion Centric (.00 mm out of occlusion) Light Centric (.2 mm out of occlusion) Default Occlusion (.35 mm out of occlusion) Acute or out of occlusion (.4 mm out of occlusion) Out of occlusion (.5 mm out of occlusion) In situations where the occlusal clearance is inadequate * If no occlusal clearance is available, please do the following: Call Doctor Reduce Opposing and mark tooth structure Reduce prep and provide a reduction coping Pontic Design * Please choose which design you prefer as a default: Ridge Lap Modified Ridge Lap Stein Sanitary Ovate Implant Crown Emergence Design * Select your default implant crown emergence design: Full Anatomical: Strong Tissue Displacement Tissue Displacement: Moderate Tissue Displacement No Tissue Displacement Implant Design * Choose default implant design when possible: Screw-retained Cement-retained Occlusal Staining * Choose default for the intensity of occlusal stain: None Light (EPIC default) Medium Strong Thank you!
