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Rx Sheets
The following Rx Sheets can be downloaded from our website. You will need Adobe Acrobat to open/print the documents.
Note: If you are requesting an appliance be made from a digital model, you will need to include an Rx for the specific appliance. Also, there is an additional laboratory fee associated with printing a model to fabricate an appliance. The fee ranges from $14-$32 depending on whether it is an upper or lower arch and on the type of base selected.
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Print an Rx Sheet
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Complete an Electronic Rx Sheet
For security purposes, we request that all electronic Rx Sheets be sent to us through our secure drop box. Download the form below, complete it electronically, save it to your computer, and then upload to our drop box.
If you have any questions, please contact us at digital@specialtyappliances.com or call 1-800-522-4636 to speak with a customer service representative immediately.
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* Click here to obtain the free Adobe Acrobat reader.
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