• Premium Dental Laboratory
    Case Submission Guide

    Organized Rx Form & Case Submission

    To help customers send cases correctly, complete the organized Rx form before submission. Fixed restoration details, removable details, preferences, and special instructions are grouped clearly for easier lab review.

    Click to copy our email for portal access, Rx form support, or case coordination.
    ℞

    Rx Form Required

    Every case should include complete instructions before submission.

    The Rx form helps our team clearly identify the case, the requested restoration, material, shade, due date, and any special instructions.

    Rx / instructions should include:

    Office / Lab Name
Doctor / Provider Name
Patient / Case Reference
Restoration / Product Type
Material / Shade
Due Date
Special Instructions
Return Shipping / Contact Info
    Important: If you need the updated Rx form, contact our team. We can provide portal support and help you submit the case correctly.
    01

    Fill Out the Rx Form

    Complete the Rx / instructions form first so every case has the correct details.

    02

    Choose Submission Method

    Send the case digitally through the designated portal or mail the physical case by postal service.

    03

    Await Team Confirmation

    Our team will review the case and follow up if anything else is needed for processing.

    Rx Form

    Rx Form

    Complete this Rx form with every case so the Simply Dentrix team can review the case details clearly. Add the patient information, restoration type, material, shade, due date, preferences, and any special instructions before submitting the case.

    Simply Dentrix Rx Form Use this form to send clear case instructions to our team. Complete the required case details, choose the correct restoration section, and include special instructions before sending your file or mailed case.
    Required With Every Case

    Case Information

    Special Instructions

    Simply Dentrix Tip: Include tooth number, restoration type, material, shade, due date, and design preferences to help prevent delays.

    Tooth Selection / Case Map

    Select tooth numbers
    Upper Arch
    Lower Arch
    Use the tooth chart to help identify which teeth are included in the case. Add additional details in Special Instructions.
    F

    Fixed Restorations

    Crowns, All Ceramic, PFM, Full Cast, Zirconia, Metal Design, and Implant-related fixed options.

    Shade Instructions

    All Ceramic / Zirconia

    Full Cast / PFM

    Metal Design

    Pontic Design

    Custom Implant Abutments

    R

    Removable

    Dentures, partials, flexible partials, night guards, trays, retainers, and removable case add-ons.

    Arch

    Denture / Partial Options

    Implant Retained Removable

    Shade

    Removable Misc.

    P

    Preferences

    Place contact, occlusion, and clearance preferences at the bottom for final review before submitting the case.

    Interproximal Contact

    Occlusal Contact

    If No Occlusal Clearance

    This Rx form is designed for Simply Dentrix case submissions. Please complete the required details before uploading through the designated portal or including the printed form with a mailed case.
    Before Sending the Case Review the completed Simply Dentrix Rx form, attach it to the digital case submission, or place the printed form inside the mailed case package.
    Final Step

    Submit Your Completed Rx Form

    Once the Rx form is completed, click the submit button to send the answers directly to the Simply Dentrix team by email. For physical mailed cases, print the completed form and include it inside the package.

    Send Completed Answers

    Review all required fields before submitting. The form will email the completed answers to Simply Dentrix.

    Email Support
    Delivery: Form answers are sent to simplydentrix@gmail.com.
    Need Help?

    Need Help Sending a Case?

    For portal access, Rx form support, mailing questions, technical issues, or case coordination, contact our team directly by phone or email.

    Phone

    714-588-7030

    Email

    Address

    1315 W Cara Dr
    Anaheim, CA 92805
    © 2026 Simply Dentrix. Customer Case Submission & Rx Instructions.
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