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, please complete an Rx for the appliance of your choice. Also, there is a laboratory fee of $8.50 per arch for printing a model to fabricate an appliance.




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.



* Click here to obtain the free Adobe Acrobat reader.