Rx Prescription Forms

Gender:Male Female

Shade*:

Pontic Design:

• A. Ridge Lap

• B. Mod. Ridge Lap

• C. Stein

• D. Sanitary

• 
  E. Ovate

Abutment Margin Depth

• Abutment Margin Depth

Abutment Margin Design

• Shoulder for All-Ceramic

• Chamfer PFM/BruxZir

Abutment Emergence Profile

• Surgical Placement

• Tissue Displacement

• No Tissue Displacement

Rx*