Prescription (Rx) Form – Physical Impression Cases
For physical impression case submissions, please complete the DSI Prescription (Rx) Form and include it inside your shipment.Â
This document provides the clinical and restoration details required for structured intake review and production authorization.
Step 1: Download the Rx Form
Step 2: Complete all required fields clearly and legibly
Step 3: Print and place the completed form inside your shipment
If preferred, you may also upload a completed copy during online case submission for advance review.
Uploading the form does not replace the requirement to include a printed copy in the physical package.Â