If you need bags, boxes, or fed-ex labels, please fill out the form.
You can now start uploading your Rx forms digitally with Pittman's RxUpload.
You can also download an Rx here:
Restoration Rx: Click image to download.
To use this printable version:
- Print out the script/Rx.
- Fill out all requested information. Please fill out all fields on the Rx. Not doing so could delay your case.
- Make a copy or scan for your practice.
- Send the original in with your case.
Prosthetic Rx: Click image to download.
Appliance Rx: Click Image to download.
Proline Rx: Click image to download.
Your Smile Factor Ortho Design Form: Click image to download.