Dentist Name:-           

                     Patient Name:-            

                     Type of work:-          

                     Shade:-                     3D        Vita

                     Select 3D Shade:-      --Select-- 1M1 1M2 2L1.5 2L1.5 2M1 2M2 2M3 2R1.5 2R2.5 3L1.5 3L2.5 3M1 3M2 3M3 3R1.5 3R2.5 4L1.5 4L2.5 4M1 4M2 4M3 4R1.5 4R2.5 5M1 5M2 5M3

                     Select Vita Shade:-    --Select-- B1 A1 A1 B2,D2 A1 A2 B3 A2 A3 A3.5 A3 A3.5 C3,C4 A4 D3 A4 B4 D3 A4 C4 A3 C4

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                     Email ID:-