Call: 914-619-4991
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Resources

Here you can find all of our downloads for prescription sheets, product information, mailing labels and general instructions. Just click the tab headings below to access the download links.

If you have any questions, please contact us at info@bmortholab.com

PRINTABLE LABORATORY PRESCRIPTION

Prescription Sheet

For your convenience, we offer our prescription forms for download.  Just save the PDF to your computer, fill out the information and either print the form and send it to us, or just upload the completed PDF in your customer portal.

All of our documents are in PDF format for the utmost in universal accessibility. Adobe Acrobat is primarily used to view these documents, and if you don’t have it, you can download it at Adobe’s website for free.

Download Printable Form or Please Fill in the below E-Prescription and Submit to the Lab.

    • Ortho Appliances
    • 168-A Irving Ave Port Chester NY 10573
    • Phone: 914-619-4991 - Fax: 914-305-4158
    • info@bmortholab.com - www.bmortholab.com

    • LABORATORY
      PRESCRIPTION

    • REQUIRED INFORMATION

      • MF

    • Standard Working time if no date is given

    • Case turnaround times are based on the date the Rx is received at the Lab. Please allow 10 business days from that date. Allow 13 business days for complex cases.

    • FIXED APPLIANCES

      HILGERS PENDULUMNANCE APPLIANCESPASSIVE LINGUAL ARCHSPACE MAINTAINERPEDO PARTIAL Upper & lowerUpper archLower arch

    • SPLINTS (*)

      FLAT OCCLUSAL SPLINTUPPER ANTERIOR REPOSITIONINGKOIS DEPROGRAMMERMORA DESIGNACRYLIC CROSS-BITE SPLINT Upper & lowerUpper archLower arch

    • SPRING RETAINERS

      UPPER 3X3LOWER 4X4 Upper & lowerUpper archLower arch

    • ESSIX ALIGNERS (*)

      B SMART ALIGNERS SETIPR NEEDSPLACE POINTICSSHADE Upper & lowerUpper archLower arch

    • RETAINERS

      ESSIX RETAINERSFIXED BONDEDHAWLEY RETAINERS Upper & lowerUpper archLower arch

    • EXPANDERS

      HYRAXSCHWARTZ EXPANDERSAGITTAL EXPANDERUNILATERAL EXPANDER3 WAY EXPANDER Upper & lowerUpper archLower arch

    • HABIT APPLIANCES (*)

      TONGUE CRIBTHUMB CRIBNIGHT GUARDSOFTHARDMIXSPORT MOUTHGUARDS Upper & lowerUpper archLower arch

    • ACCESSORIES

      LABIAL BOW 6 TO 6FULL LABIAL BOW WRAP AROUNDADAMS CLAPSBALL CLAPSARROW CLAPSC CLAPSCOVER OCCLUSALBITE PLAINSMOUTHGUARDSCOLOR OR DESIGNED Upper & lowerUpper archLower arch

    • RX SPECIFIC INSTRUCTIONS

      Please provide any additional instructions, or provide any photos, study models or scanned files if needed


    (*) - UPPER AND LOWER MODEL WITH BITE NEEDED

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