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  • 800-999-7122
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Giving you more reasons to smile.

Removable Preference Sheet

Please complete this form and return it to us as soon as possible; this is an excellent tool for us to better serve you.

Removable Preference Sheet

"*" indicates required fields

Name*
MM slash DD slash YYYY

Dentures

Base plate*
Soft Liner*
Denture Base Material*
Tooth Preference: Anteriors*
Tooth Preference: Posteriors*
Finished Prosthesis*
Peripheral Roll*
Immediate*
Name in Denture*
Custom Tray*
Articulator Preference*

 

Partials

Acrylic*
Frames*
Try-In*

 

Splints

Splint Options*
Splint Instruction 1*
Splint Instruction 2*
This field is for validation purposes and should be left unchanged.
Kelley Dental Laboratory
812-945-7122