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Lab Order Form
(385) 347-4069

For dentists

Lab Order Form

Our paper Rx, online. Fill it out once and it lands with the technician who'll work your case — no printing, no faxing, no guesswork.

Prescription

Send us your case.

Required fields are marked with an asterisk. Questions before you send? Call (385) 347-4069 or email clearfield@naturessmiles.com.

Nature's Smiles Dental Laboratory

Nature's Smiles Dental Laboratory

Science, Art and Nature in a Smile

We Accept Digital File.

Doctor information

Not on the paper form — we use it to confirm receipt of your order.

Patient information

Prescription

Denture
Partial
Other product

Shade & digital files

We accept digital files. Paste a share link to your scan, photos or design — or email them to clearfield@naturessmiles.com.

Teeth involved

Tooth chart

Select the teeth involved in this case. Universal numbering — upper 1–16, lower 17–32, laid out as they sit in the mouth.

Upper arch (1–16)
Lower arch (17–32)

Selected: No teeth selected

℞ Notes to technician

Authorisation

Typing your name here is your electronic signature for this order.

Credit Terms

If credit is extended, statements are due and payable in full within 30 days. Any past due amounts will be charged a 2% finance charge monthly on full balance. If not paid within terms, Client will be responsible for all collection and attorney fees to collect balance owed.

Contact Us

Nature's Smiles Clearfield (385) 347-4069 email: clearfield@naturessmiles.com