Labslip

Doctor / Office Information

Patient Info / Due Date

Prescription

ㆍRetainer

- Standard Hawley Retainer
- Circumferential Hawley Retainer
- Hawley with Flat Bow Retainer
- Circumferential with Flat Bow Retainer

ㆍPressform Appliance

- Essix
- Bleaching Tray
- Soft Night Guard
- Sports Guard
- EZ Bonding

ㆍRemovable Appliance

- Schwartz Appliance
- Sagittal Appliance 2 Way
- Fan Type Removable Expander
- Three Way Expander

ㆍFixed Appliance

- Lingual Holding Arch
- Nance
- Thumb Habit with Spurs
- Tongue Habit
- Tongue Habit with Loops
- Tongue Bead
- Transpalatal Arch
- Fixed Anterior Bite Plate
- Rickanator/Bite Ramp

ㆍSplint

- Hard Acrylic Night Guard
- Thermoplastic Night Guard
- Gelb
- NTI
- M-MARPE®
- Fixed Sagittal

ㆍDistalizer Appliance

- Lip Bumper
- Distal Jet
- T-Rex / Pendex
- Pendulum

ㆍFixed Expander

- Bi Helix
- Arnold Expander
- Porter Expander
- Fan Type Expander
- Rapid Palatal Expander
- Compact RPE
- Bonded RPE
- Haas
- Quad Helix

ㆍFunctional Appliance

- Bionator without Screw(open)
- Bionator without Screw(close)
- Twin Block Without Screw
- Herbst Telescopic with TPA and LLHA
- MARA with TPA and LLHA

DRAWING

COLOR CHART

OVERVIEW

SELECTED APPLIANCE

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Instructions

Special Requests

Case Type

INSTRUCTION

1. Print out lab slip
2. Send Impression Model and lab slip to:
11917 Front St, Norwalk, CA 90650