FIXED LABORATORY WORK AUTHORIZATION FORM: Fill out & sign online

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Click ‘Get Form’ to open the FIXED LABORATORY WORK AUTHORIZATION FORM in the editor.
Begin by entering the Doctor's name and the Rx Date. Ensure these details are accurate as they are crucial for processing.
Fill in the Patient's information, including their name, age, and sex. This helps in identifying the patient for whom the work is authorized.
Provide SHADE INSTRUCTIONS by selecting options for Stump Shade and Final Shade. Choose from None, Light, Medium, or Dark based on your requirements.
Select the type of All-Ceramics needed by checking appropriate boxes such as Porcelain Veneer or PFZ Porcelain-Fused-to-Zirconia.
Indicate Implant Type if applicable, choosing between Screw Retained or Cement Retained options.
Complete sections for Porcelain-Fused-to-Metal Alloy Type and Facial Margins according to your specifications.
Ensure you have included all necessary items like Bite, Photos, and Pre-op Model by checking the corresponding boxes.
Finally, sign the form with the Dentist's signature and license number before submitting it through our platform.

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