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967 W 7th St, Oxnard
(805) 834-1066
718 New Los Angeles Ave. Unit B3 Moorpark
(805) 744-6455
M - F: 9:00AM / 6:00PM
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Endodontics
Orthodontics
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Home
About Us
Specialities
Endodontics
Orthodontics
Prosthodontics
Periodontics
Oral Surgery
Pediatric Dentistry
Dental Imaging Lab
Our Doctors
Referral Form
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Contact
Make an Appoinment
Home
About Us
Specialities
Endodontics
Orthodontics
Prosthodontics
Periodontics
Oral Surgery
Pediatric Dentistry
Dental Imaging Lab
Our Doctors
Referral Form
Documents
Lab Slip
Lab Slip Online
Contact
Menu
Home
About Us
Specialities
Endodontics
Orthodontics
Prosthodontics
Periodontics
Oral Surgery
Pediatric Dentistry
Dental Imaging Lab
Our Doctors
Referral Form
Documents
Lab Slip
Lab Slip Online
Contact
Lab Slip Online
Lab slip Online Referral
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Ally Dental Specialties Dental Lab Division
Email: Allydentalhelp@gmail.com Phone: 805-834-1066 Address: 967 w 7th St, Oxnard CA 83030
Header
Dentist:
Address:
RX DATE
DUE DATE
Header
City/State/Zip:
Phone:
Header
Patient’s Name
DOB
Check List
Enclosed:
Impresion:
Bite:
Models:
Photos:
Other:
REMOVABLE RESTORATIONS
Toothshade
Check List
Upper/ Lower
Check List
Metal Partial
Stayplate
Resin Partial
Full Dentures
Flexible Partials
A
A- Custom Trays
B
Framework
Standard Chromium Cobalt
Premium Vitallium 2000
C
Bite Registration
D
eeth Set Up
[Economy] [Plus] [Premium]
E
Standard Acrylic
Premium Lucitone
Process/Finish
F
Bleaching Tray
G
Athletic Mouth Guard
H
Night Guard
Select Shade:
Pink Dark
Pink
Veined
REPAIR
Economy
Plus
Premium
Add tooth to partial
B
Reline
C
Rebase
D
Metal Mesh
PFM
Non-Precious
Semi- Precious
Yellow Gold
White Gold
All Ceramic
IPS E.max
Inlay/Onlay
Veneers
Zirconis
PFZ
Semi- Precious
Zir Lingual
Zir Occlusal
Full Cast
Yellow Gold
White Gold
Semi-Precious
Non-Precious
Pontic
Full RIDGE
Partial RIDGE
Modified Partial Ridge
Deep Into Gum
Metal Design
Full Metal Lingual
Full Porcelain Coverage no metal exposed
Metal LingualCollar
3/4 Metal Lingual
Metal Lingual Collar
Metal Margin
1/2 Metal occlusa
Full Metal occlusal
Occlusal Contact:
Open
Ligth
Heavy
Proximal Contact:
Ligth
Normal
Tigth
Embrasure:
Close
Normal
Open for Cleaning
Occlusal Staining:
None
Ligth
Medium
Heavy
NOTES
All work requires 7 business days turnaround time
License #
Signature
Date
MM slash DD slash YYYY
Same Day
24 Hr Next Day
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