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Laboratory Prescription Form (4 books)

Perforated across the top for easy tear-off. Consecutive tracking number on each set for your added convenience.Approved by the Missouri Dental Board. Note: Missouri state law requires a copy of the work order indicating shade verification shall be retained by the lab AND dentist for 7 years from the date appearing on the order or the date of prescription.
Measurement: 5.5" wide by 8.5" high. Contains 50 forms per book, each with carbon copy and wrap around cover. Quantity: 4 books.


Click here to view a sample form.

Contact: MDA Office Manager
Email: info@modental.org
Phone: 573-634-3436


MDA Members $30.00

Non-Members $60.00

 


 
 
 
 
 
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