Premium Dental LaboratoryCustomer Case ResourcesDownload, Complete & Submit Your Rx Form.
Choose the detailed or simplified Simply Dentrix prescription form. Complete the fillable PDF on your computer, save it, and email it with any scans, photographs, or supporting case files.
Download Detailed RX Form Download Simplified RX FormThe completed PDF must be saved and manually attached to your email.Rx Form Required
Please include one completed prescription form with every submitted case.✓ Doctor, practice, patient, due-date, and case details.✓ Restoration, material, shade, and design selections.✓ Supporting scans, photographs, and special instructions.Official Fillable PDFsChoose the Best Form for Your Case
Both forms can be completed electronically. Select the detailed form for more complex cases or the simplified form for routine submissions.
Detailed RX Form
Best for complex or highly customized cases requiring additional restorative, removable, design, and case-instruction options.
Download Detailed Fillable PDF✓ Expanded restoration and material selections✓ Shade, tooth, margin, and design information✓ Additional case notes and enclosed-item detailsOpen the downloaded file in Adobe Acrobat Reader, complete it, and save a new copy.Simplified RX Form
A cleaner and faster option for routine fixed restorations, removable cases, and straightforward laboratory instructions.
Download Simplified Fillable PDF✓ Quick doctor, practice, patient, and due-date fields✓ Fixed and removable case selections✓ Case instructions and enclosed-item informationOpen the downloaded file in Adobe Acrobat Reader, complete it, and save a new copy.How It WorksComplete Your Submission in Three Steps
Keep the completed prescription and supporting case files together so the Simply Dentrix team can review the case efficiently.
1Download
Select the detailed or simplified fillable Rx PDF and save it to your device.
2Complete & Save
Enter all case details, select the appropriate options, and save the completed PDF.
3Email the Case
Attach the saved Rx form along with scans, photographs, and any other supporting files.
Adobe Acrobat Pro is not required for normal form completion. Customers can generally use the free Adobe Acrobat Reader to type into the fields, select checkboxes, save the completed form, and print it.Submit Your CaseSend the Completed Form to Simply Dentrix
Attach the completed Rx PDF and supporting digital case files to your email. For physical impressions or models, include a printed copy of the prescription with the package.
Start Case Submission EmailEmail simplydentrix@gmail.comPhone 714-588-7030Mailing Address Simply Dentrix
1315 W Cara Dr
Anaheim, CA 92805