REQUEST A PICKUP

Please fill out the form below to schedule a pickup.

Date *

Doctor Name *

Clinic Name *

Address *

Patient Name *

(Do not schedule cases before 11:15am in Austin 12:15pm outside Austin. Thanks!)

Due Date *

Time *

Cases with improper due date will be charged with a rush fee. Please call if you need help.

Same day service will need to be called in before 8:30am and ready to pick up no later than 8:45am. Case will be delivered by 4:30pm. Thanks!

Does not include day of pickup or delivery.

Removable Restorations *

Fixed Restorations *

RX Instructions

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