Digital Rx

Practice*

Doctor*

Patient Name*

First Last

Today’s Date*

Due Date*

Print Diagnostic Casts

Print digital wax up

Surgical Guides:*

Tooth Borne

Bone Borne

Mucosa Borne

Stackable

Implants to be planned/ tooth #:

Implant brand/ connection:

Implant Size:

Custom healing abutments needed?

Immediate temporary needed?

Any special notes:*

Directions for case submission:
Fill out this digital script, download RealGuide software, upload CBCT onto RealGuide along w/ digital scans, share the case with nocolaborders@gmail.com , Send us an email confirming the case is sent.