IDS Lab Cooperative Intake Form

First & Last Name *

Phone *

If I need to call you to discuss expectations and clarify your answers, what is/are the best times to call? *

What is the average number of crowns you produce per month? *

What are your two most popular implant platforms you work with?

Do You Routinely Take Photos? *

YES

NO

If yes above, What do you typically use to take these photos?

Smartphone/Tablet

Digital Camera

Intra-Oral Camera

OtherOther

Do you routinely take stumpf shades when selecting final tooth shades? *

YES

NO

If "Yes" to the above, Do You Use The ND Shade Guide (Ivoclar)?

YES

NO

What type of Impressions do you take? *

If Digital, What Scanner Do You Use? *

Emerald by Planmeca

TRIOS by 3Shape

Element 2 by Itero

OtherOther

For Opposing, Do you require that we contact you prior to the adjustments described below? *

YES

NO

From time to time we may find it necessary to make slight adjustments to either the opposing arch or the prep itself to properly complete a restoration. We will provide a reduction coping if the prep requires adjusting.

For Prep, Do you require that we contact you prior to the adjustments described below? *

YES

NO

From time to time we may find it necessary to make slight adjustments to either the opposing arch or the prep itself to properly complete a restoration. We will provide a reduction coping if the prep requires adjusting.

Does UPS deliver to your office on a regular basis? *

YES

NO

What is Your Required Turnaround Times? *

Please Provide Your Office Hours *

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