RiverRock Dental Laboratory

Prescription

DOWNLOAD our Rx Form (PDF format - download Adobe Reader if you do not have it)

Complete and Fax to 231-929-7776 AND place copy of completed Rx form with your case.

To provide more depth and context, feel free to complete this optional online form. Be sure to provide your name and the patient's first name and last initial to help us match this information with the Rx Form, which should come with their case.

Your Patient's Needs

* Mandatory fields

A few statements can be sufficient - more is better. This is not necessarily clinical information - we want to know what the patient's expectations are.

Clinician's Name *

Client Code *

Practice Address *

Suite/Building

City *

State *

Zip Code *

Phone *

Email *

News

2006-09

High-Quality Assurances

Dear Doctor:

My team and I will demonstrate RiverRock Dental Laboratory superior quality. We start with a pledge of "no adjustments" and finish with a fantastic look and flawless function.

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