Case Submission Form

Print this prescription form, fill it in, and include it with your case. Or save it as a PDF directly from your browser's print dialog.

How to Fill This Out

Every field on the form maps to a clinical detail our technicians need to fabricate the restoration accurately. Here's what each one is asking for.

Use Universal Numbering System (1–32). For bridges, list all abutments and pontics in order.

Crown, bridge, implant crown, veneer, or inlay/onlay. Check all that apply on the form.

HT, HT Multilayer, or Super Translucent Multilayer. Unsure? See our material guide linked below.

VITA Classical (A1–D4), Bleach shade, or attach a shade tab photo taken in natural light.

Bite concerns, bruxism history, opposing arch details — anything that affects the final design.

For tracking purposes — initials or an internal case number is fine.

Not sure which material to specify? Read our zirconia material guide.

Send PVS or polyether impressions, bite registration, opposing arch, and a shade photo. Pack securely to avoid distortion.

Email STL or DCM files from CEREC, 3Shape TRIOS, iTero, Medit, Carestream, Planmeca, or 3M True Definition to yourlab@rivfordental.com.

Practices in Miami-Dade or Broward — call us to schedule. Mon–Fri 9am–5pm. Same-day pickup available before noon.

Want the full walkthrough? Read the step-by-step guide.

Our team in Hialeah can answer any questions about a case before you send it. We're happy to walk first-time clients through the form over the phone.

3750 W 16th Ave, Suite 242-U, Hialeah, FL 33012

Monday – Friday, 9am – 5pm