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1 Step 1
Let's Revolutionize Dentistry Together
BASIC INFO
Office Closed:
To protect your sensitive data, Gold Dust will send to the email above a separate form for you to provide a billable credit card.
All new accounts must guarantee payment by keeping a current credit card on file.
EMAIL COMMUNICATIONS
I would like the following emailed:
I would like the following emailed:
I would like the following emailed:
I would like the following emailed:
I would like the following emailed:
I would like the following emailed:
CLIENT PREFERENCES
To ensure that we meet your expectations it is essential that we receive this information from you with your first case! Thank you!
1. What materials do you prescribe:
2. What problems have you had with other labs?
3. Crown & Bridge
Posterior clearance issues, we should:
Anterior clearance issues we should:
Occlusion:
Contacts:
Pontic Designs:
Undercuts on Prep:
6. Do you utilize an Intra-Oral Scanner?
7. Do you place implants?
2242 S. McClintock Drive, Ste. 1 Tempe, AZ 85282 ph: 800.513.6131 • fax: 480.968.8831 • www.GoldDustDental.com
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