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Rx
Universal Rx
For all your restorative needs

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Fixed Rx
Fixed restorative needs only

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Removable Appliance Rx
Removable Appliance needs only

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Click on "Type & Print" to open the PDF file. Type in the required information and Print the form to ship with your case. You may need to upgrade to the most current version of Adobe Reader to view the Rx. Click here to upgrade to the most recent version of Adobe Reader.