Medium

Available on

Apple Android Windows

Dental Labortatory Rx Form Mobile App

The Dental Laboratory Rx Form mobile app allows dentist and dental technicians to complete a dental lab request form using a smartphone or tablet. This form can be sent to the insurance company for pre-approval or directly to the lab for processing.

Dental technicians can specify the details of the dental lab request, along with details about the requesting dentist or dental practice, the patient and the items needed from the dental laboratory. The app covers all major dentistry items, including dental implants, dental restorations, partial dentures and full dentures, porcelain veneers and more. Once the request has been completed, the dentist can email it directly to the lab. GoCanvas has thousands of pre-built mobile business apps in our Application Store

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Take a peek inside the Dental Labortatory Rx Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    DOCTOR:

  • Ico textbox

    PATIENT:

  • Ico textbox

    PHONE:

  • Ico date

    DATE SENT:

  • Ico textbox

    WANTED:

  • Ico checkbox

    PLEASE CALL DOCTOR BEFORE STARTING THIS CARE

  • Ico textbox

    SHADE #

  • Ico statictext

    OCCULUSAL STAINING

  • Ico checkbox

    NONE

  • Ico checkbox

    LIGHT

  • Ico checkbox

    MEDIUM

  • Ico checkbox

    HEAVY

  • Ico statictext

    SURFACE TEXTURE

  • Ico checkbox

    SMOOTH

  • Ico checkbox

    MODERATE

  • Ico checkbox

    HEAVY

  • Ico statictext

    LUSTER

  • Ico checkbox

    SHINY

  • Ico checkbox

    MODERATE

  • Ico checkbox

    DULL

  • Ico drawing

    SHADE INSTRUCTIONS

  • Ico statictext

    Please Provide the Following Information

  • Ico statictext

    PURPOSE OF VENEER

  • Ico checkbox

    CHANGE COLOR

  • Ico checkbox

    CLOSE SPACE

  • Ico checkbox

    CORRECT MALALIGNMENT

  • Ico checkbox

    INCREASE LENGTH (mm)

  • Ico decimal

    INCREASE LENGTH (mm)

  • ...and More!

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