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Rx ONLINE FORM

Submitting your dental cases has never been easier. Our Rx Online Form is a secure, streamlined solution for dentists and orthodontists to upload prescriptions, case details, and supporting documents directly to our lab.

Rx FORM
Dr
Email
Phone
Order Date
Patient Name
Patient Age
Delivery Date
Delivery Time
Delivery Address
Upper Teeth
Lower Teeth
Instruction
Office Use Only
Please Specify
Centric Contact
Labial Margin
Margin Adaptation
Lateral Excursion
Pontic Design
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Contact (Embrassures)
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Special Shade Selection
Electronic signature

Thanks for submitting!

Orthodent Ltd.

92 Bowers Ave

Runnemede NJ

08078

Your Full-Service Dental Laboratory
Specializing in Orthodontics

Serving North America Since 1988

HOURS

Monday: 8: 30 am - 5 pm

Tuesday: 8: 30 am - 5 pm

Wednesday: 8: 30 am - 5 pm

Thursday: 8: 30 am - 5 pm

Friday: 8: 30 am - 5 pm

Saturday & Sunday: Closed

CONTACT US

Phone: 1 (856) 939-5666

Fax: 1 (856) 939-5669

Email: info@orthodentlabs.com 

Leadership • Bill Van Evans   |   Our Commitment   |   About Us

Accessibility   |   Warranty   |   Forms   |   Brands   |   Careers

ORTHODENT USA LTD. © 2025  ·  ALL RIGHTS RESERVED
Designed By: Alero ®

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