Premium Dental Laboratory
Customer Case Resources

Download, 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 Form
The 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 PDFs

Choose 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.

✓ Expanded restoration and material selections
✓ Shade, tooth, margin, and design information
✓ Additional case notes and enclosed-item details
Download Detailed Fillable PDF
Open 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.

✓ Quick doctor, practice, patient, and due-date fields
✓ Fixed and removable case selections
✓ Case instructions and enclosed-item information
Download Simplified Fillable PDF
Open the downloaded file in Adobe Acrobat Reader, complete it, and save a new copy.
How It Works

Complete Your Submission in Three Steps

Keep the completed prescription and supporting case files together so the Simply Dentrix team can review the case efficiently.

1

Download

Select the detailed or simplified fillable Rx PDF and save it to your device.

2

Complete & Save

Enter all case details, select the appropriate options, and save the completed PDF.

3

Email 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 Case

Send 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.

Email simplydentrix@gmail.com
Phone 714-588-7030
Mailing Address Simply Dentrix
1315 W Cara Dr
Anaheim, CA 92805
Start Case Submission Email