ORDER FORM

If you prefer not to checkout online, please print the order form, fill it out and include it with the denture when you ship it to us. We will contact you and help you pay for the repairs over the phone.

Customer information:
Denture/ Acrylic Partial/Retainer/Nightguard Repair:
Remove Glue $29.00
Cleaning & polishing $39.00
Simple Crack $79.00
Add metal reinforcement $29.00
Complete Break $99 /
Teeth Repair/ Gold Denture Teeth:
Remove Glue $29.00
Gold Denture Tooth $275.00
Replace one tooth $79.00
Cleaning & polishing $39.00
Additional Teeth $29.00 per additional tooth
Reinforce tooth with wire $29.00
Flexible Partial Repair:
Remove Glue $29.00
Replace one tooth $99.00
Repair Base Material $99.00
Additional Teeth $39.00 per additional tooth
Duplicate Denture (We cannot duplicate flexible partials!!!):
Duplicate Denture $149.00 per denture
Duplicate nightguard $99.00
Duplicate acrylic partial $139.00 (clasps cannot be duplicate)
Make duplicate denture with whiter teeth than original denture: No Additional Charge. Please indicate new shade using shade guide below

Please use the shade guide bellow to determine which shade you prefer for your duplicate denture. Please check the box for the corresponding shade in the form bellow the shade guide.

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Duplicate dentures shades. Please check the box for your preferred shade.*
*Due to differences in screen resolution, shade may not be exactly as indicated but it will be as close as possible.

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Return Shipping
USPS Return shipping via Priority mail (3-5 days) is INCLUDED with repair fees.
For quicker return shipping, please select from the following options on the checkout page:

UPS 2nd Day Air: $35 USPS Express: $15

Print Prepaid Label