Great Lakes Orthodontics



 


 

Rx Forms

Prescription Forms

Download prescription forms by clicking on the links below.   
Aligner Appliance Rx Metal Appliance Rx
Athletic Mouthguard/Bleaching Tray Rx Perio Protect™ Tray Rx
Diagnostic Study Model Rx Removable Appliance Rx
Elastodontic/Positioner Rx Smart Moves® Rx
Functional/Active Plate Rx Snoring/Sleep Apnea Rx
Herbst®*/X-Bow™/Acrylic RPE Rx Splint/Deprogrammer Rx
Indirect Bonding Rx Twin Block Rx

 

 

 

 

 

 

 

 
 

We can also fax them to you.  
To speak with a laboratory customer service representative:
Please mail me RX Forms

 

 

Phone: 800-828-7626 (U.S. & Canada) or 716-871-1161 (Worldwide)
Hours: Monday - Friday 8:00a.m. to 5:00p.m. (EST)
Email: labcustserv@greatlakesortho.com

*Herbst is a registered trademark of Dentaurum, Inc.
 
In order to view these forms you will need Acrobat Reader installed on your computer which is available
as a Free Download here.