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Smart Rx

ILLUM's

Please fill out the blank below and select or choose the option for ordering your case.

Required Information

If you have more files to upload please send the file to

support@illumdental.com with the subject line including the information as below. we will confirm as soon as available.

* Please includes your lab name, patient name,
order date on the subject line 

SUBMIT

Smart Rx

 Thanks for place your order. Please fill out the blank below and select tooth you want to make order on the image on the left side. If you have any question about this Smart RX form, Please call us 714-602-6477 or Email us to illumdental@gmail.com. Thank you so much.

RX_덴처완성.png

Please  MUST  select the tooth here

* Your Name (or Company Name)

* Phone Number

* Address

* Email

Case Information

* Patient Name

* Submit Date

* Due Date

* Please check the tooth number to order

* Bridge / Splint Units

* Please select the type of work

* Total Number of unit 

EA

* Shade

Detail & Option Information

 * Material Selection  

Select Corresponding Option for your order

Coping (Choose One)

Full Crown / Onlay,Inlay / Implant Crown (Choose one)

UPLOAD - 1st File
UPLOAD - 2nd File

Abutment Brand

Hybrid Custom Abutment *Shade*

 * Hole Option 

 * Glazing Option 

UPLOAD - 3rd File
UPLOAD - 4th File

Detailed Memo

Please give us more detail about the case

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