Order Form

Complete order form and click print button to print out the form. Credit card information is optional. It will be obtained over the phone at the time of order confirmation, once dental appliance is received. Shipping is free with prepaid label or use any shipping carrier of your choice. Repaired dental appliance will be shipped back with free USPS Priority mail. Upgrade to USPS Express for $25.
Print Form

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          Money Order     
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Signature:___________________________________________    

I have read and agree to the Denture Repair Lab Policy and authorize Denture repair Lab to charge my credit card for the services provided.


Glue Removal $29.00 Metal Reinforcement $29.00     Rebuild Gum Area w/ New Acrylic $189.00
1 Crack/Break/Fracture $89.00 Duplicate Denture $349 /   Duplicate Partial $399.00
2 Cracks/Breaks/Fractures $125.00 Professional Cleaning & Polishing $49.00
3 Cracks/Breaks/Fractures $155.00 90 Day Warranty $45.00

Glue Removal $29.00 Metal Reinforcement $29.00     Rebuild Gum Area w/ New Acrylic $189.00
1 Tooth (you supply tooth) $95.00 1 Tooth ( lab supply teeth) $115.00
2 Teeth (you supply teeth) $135.00 2 Teeth (lab supply teeth) $185.00
3 Teeth (you supply teeth) $185.00 3 Teeth (lab supply teeth) $225.00
Duplicate Denture $349 /   Partial $399.00 Cleaning /Polishing $49.00     90 Day Warranty $45.00

Glue Removal $29.00 Metal Reinforcement $29.00
1 Crack/Break/Fracture $219.00 1 Tooth (you supply) $185.00 1 Tooth (lab supply) $205.00
2 Cracks/Breaks/Fractures $259.00 2 Teeth (you supply) $215.00 2 Teeth (lab supply) $235.00
Duplicate Partial $399.00 Cleaning & Polishing $49.00 90 Day Warranty $75.00

Duplicate Denture $349.00 1Shade Whitter Teeth $35.00
Duplicate Partial (non metal) $399.00 Cleaning & Polishing $49.00
Duplicate Hard Nightguard $349.00 90 Day Warranty $45.00
Additional Instructions


Please mail your denture to:
Denture Repair Lab
541 Newport Ave
Pawtucket RI 02861
TOTAL
Print Form