Lab Form

Lab Form PDF

Click here for the Lab Form PDF or fill out the online form below.

Case File Upload

Click here to upload your case files photos. We accept the following files: iTero, 3M, Carestream, and Trios.

Doctor Contact Info

Date:*

Name:*

Email:

Phone:

Address:

Patient Info

Gender:

Age:

Patient Name:*

Tooth Number(s):*

Select Shade Guide:

Shade:

Stump Shade:

Cement Date:*

Items Included With The Case

Select items included:

If "Other," please explain:

Type of Restoration Desired

Select type of restoration:*

If "Other," please explain:

Case Notes and Goals

Please type out any necessary notes and goals:*

Doctor's Electronic Signature:*

Doctor's License Number:*

Implant Restorations

Type of Restoration:

If Screw Retained

Select:

If Cement Retained

Select Custom Abutment:

If "Other," please explain:

Please enter the text you see:

Additional Ordering Information

* Implants with zirconia connections will be manufactured by Nobel Biocare, Straumann, or Atlantis.

** Implants with metal connections on zirconia abutments can be milled by Group 4 Dental Lab or Nobel Biocare.

Metal connections are cemented to the zirconia abutment in lab. Pricing varies by manufacturer, most companies can produce platforms on their competitors, call us or consult your rep for more information. Group 4 Dental Lab warranties zirconia custom abutments for breakage or defects in workmanship for 5 years. No warranty is provided for the implant fixture itself. Some implant companies will negate their warranty on the implant if the abutment used is manufactured by a competitor, partner, or third party. Group 4 Dental Lab assumes no responsibility for the implant fixture. Please consult your warranty information provided by the implant manufacturer.

CONTACT
Phone: (503) 297-2431

LOCATION
Group 4 Dental Lab
14791 SW. Millikan Way,
Beaverton, OR 97006-2388

Proudly partnering with

Group IV Dental Laboratory, 14791 SW. Millikan Way, Beaverton, OR 97006-2388 - (503) 297-2431 - group4dentallab.com - 11/3/2023 - Page Terms:dentist Beaverton OR -

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