Request Supplies

Pittman Dental Laboratory (PDL) Rx is available in PDF format. The form is best viewed with the latest, free Adobe Acrobat Reader software. You are permitted to save the form to your hard drive for future use.

→ Print Platinum Rx
→ Print Proline Rx

The work authorization Rx forms must be submitted clear, legible and express your specific intention for each case submitted to the laboratory. You may email the form to Pittman Dental Laboratory (PDL) click here or fax it to fax 770-503-1173.

If you experience difficulties downloading or printing the Rx, you may also request it by postal mail or phone.

Call Toll Free (800) 235-4720  or  Call Local 770-534-4457.

	1. Submit your data Dr. Name: * City: * State: * Phone Number: * Date of Request 2. Request Supplies Request Supplies: Standard Rx Proline Rx International Rx FedEx Return Labels: 2 Day Express Other Supplies: FedEx Bags Boxes Route Bags Route Labels Your Message: