RX ORDER FORM*Please fill out rx Name * First Name Last Name Practice Name * Doctor License # Email * Phone * (###) ### #### Desired return date * MM DD YYYY Patient name Patient sex Male Female Patient age Patient tooth shade * Digital or analog? * Digital Analog Both Is this your first case with AOX IMPLANT STUDIO? * Yes No Have you completed the new contact form? * Yes No What type of case are you sending in? * Hybrid Crown, Veneers, Bridge, or implants Removables =Diagnostic Waxup & DSD (Digital Smile Design) Surgical guide TO STREAMLINE DIGITAL FULL ARCH WORK FLOW HERE ARE SOME RECOMMENDATIONS. ALL MUA OR SRA'S ARE COMPATIBLE WITH NOBEL, BIOHORIZONS, STRAUMANN, NEODENT, AND 3i. THE RECOMMENDED SCAN BODY IS FROM DESS PART 52.007. SCANS REQUIRED: SCAN OF CURRENT PROVISIONAL (CONVERTED DENTURE OR 360 DENTURE SCAN WITH WASH. SCAN OF OPPOSING WITH DIGITAL BITE AND A FINAL SCAN OF THE DESS SCAN BODY. Desired final restoration type * All on zirconia with ti bases Metal Supra-Structure w/ Crowns All Zirconia Direct to MUA Metal Supra-Structure w/Acrylic See Specific Instructions Specific instructions Requested Product at This Time * Custom Tray Bite Block Metal Supra-Structure w/ Crowns All on Zirconia Verification Jig Dual PMMA Acrylic to Metal Frame See Specific Instructions Specific instructions Implant system * Implant system details * Specific instructions You can send photos and STL files to our email aoximplants@gmail.com using https://wetransfer.com/account * If you have patient photos please included the in the link* Yes I sent photos No I have not Thank you! We Transfer Link
