HACKNEY DENTAL LABORATORY
ACN 008 129 735
Specializing in Crown & Bridge

Geoff Bills

Prudential Building, 9th Floor,
195 North Terrace, Adelaide, S.A. 5000
Phone 08 8223 5266
Fax 08 8223 2399
email gbills@adelaide.on.net
www.hackneylab.com.au

DATE SENT:

DENTIST: PHONE:

PATIENT: AGE:

SHADE: CASE:

TEETH:

PREFERRED ALLOY TYPE:

RIDGE RELIEF:
NONE SLIGHT MED. HEAVY

CONTACTS:
OPEN CLOSED

PONTIC DESIGN:
FULL RIDGE PARTIAL RIDGE NO RIDGE POINT CONTACT NO CONTACT

SPECIAL TRAYS

BITE

TRY IN

RE-TRY

FINISH

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