Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin by entering the prescribing doctor’s name in the designated field at the top of the form, followed by their address, city, state, and zip code.
3. Place the laboratory sticker in the specified area on the form.
4. Fill in the doctor’s phone number in the relevant field, followed by the patient’s name.
5. Select the gender of the patient by marking the appropriate box next to ‘Male’ or ‘Female.’
6. Indicate the delivery date for the restoration in the ‘Deliver By’ field.
7. Choose the appropriate Straumann CADCAM materials by checking the corresponding box for the options provided such as ‘Zerion,’ ‘Ticon,’ ‘Coron,’ or ‘Polycon AE.’
8. Specify the type of material you require, such as ‘IPS e.max® CAD Restorations,’ ‘Titanium,’ or ‘ZrO2’ by marking the relevant box.
9. Proceed to the specific instructions section and acknowledge that only genuine Straumann components should be used.
10. Select the desired crown and bridge options by checking appropriate choices for the margin types and pontic designs based on the case requirements.
11. Include the doctor’s signature to authorize the prescription, and do not forget to input the license number and date.
12. Finally, remember to enclose any necessary models, impressions, or bite registration templates with the form before submission. Ensure that no substitutions are made.
13. Once all sections are completed, save the changes, download, print, or share the form as needed.

Complete your prescription form online today for efficient and accurate dental restoration processing.