Emergency RX

Fast Access When You Need It Most

We know emergencies don’t follow business hours—and when a patient is in pain or a case needs to move fast, you need a solution now. That’s why we’ve made our Emergency RX Forms available for quick and easy download.

Whether it’s a last-minute denture, a same-day crown, or a case that can’t wait until morning, this form ensures we get the information we need to get started—without delay.

📝 Download Emergency RX Form

Simple, fillable, and ready to send. Use this form for any rush or time-sensitive cases.

By signing or sending this RX slip (or a substitute therefore) to A.D.L. Dental Lab, the prescribing dentist individually and on behalf of the billing dentist or entity, represents that he or she has the authorization of the billing entity to bind said entity and on behalf of said entity and individually does agree to abide by all terms and conditions listed below.

LIMITED LIABILITY

In the event the case or item is lost or damaged for any reason, the liability of A.D.L. Dental Lab shall be strictly limited to a full refund of the amount paid or a remake or repair at no additional charge. A.D.L. Dental Lab shall not be liable for incidental or consequential damages, including inconvenience, lost wages, chair time or pain and suffering.

TERMS

All statements OR required retainer amount must be paid in full by 10th of the month in which the statement is prepared. Any amount not paid by the 10th of such month will incur 2% service charges (annual rate of 24%) per month, and the account shall be automatically placed on C.O.D. terms. Orders on past due accounts will be delivered on C.O.D. basis with past due added. All cases will be billed in stages and will be paid in full according to the stage. All cases and items sent shall remain the property of A.D.L. Dental Lab until client's account is paid in full. A minimum of $50.00 will be charged for returned checks. All disputes shall be governed in all respects by Pennsylvania law with venue in Montgomery County, with the prevailing party to recover attorney's fees, court costs and other expenses, including actual expert witness fees, if any, in addition to any other relief to which prevailing party may be entitled.

WHAT IS COVERED

Repair or replacement of appliance/prosthesis within Six Months.
• Prosthesis with fresh or recent extractions must be relined by lab or chairside immediately after insertion. Valplast prosthesis with fresh or recent extraction are not covered under warranty.

CONDITIONS WHICH MUST BE MET FOR WARRANTY TO APPLY

I. Prosthesis must be inserted by a licensed, practicing dentist. 
2. Patient must adhere to semi-annual dental maintenance (cleaning and exam) program, in the office of a licensed and practicing 
3. The maintenance schedule in the patient - chart must be documented by the attending dentist each visit to validate this warranty. Such documentation shall be available for A.D.L. Dental Lab review, upon request. 
4. RE-MAKE. RE-DOOR ISSUE OF CREDIT: Original case must be returned with a new impression for re-making or re-doing the case. Dental prosthesis must be returned with model-work in order for the credit to be issued. Remake or Re-do of the cases are covered for Six Months and subject to return of the original appliance/prosthesis with new impression and details of the case such as patient's name and original date of insertion or trial. If you use original appliance/prosthesis as a temporary restoration for your patient, the warranty shall be void and the case/prosthesis will be treated as new case and charged in full. Warranty is for Six months from delivery date. 
This warranty is in lieu of all other warranties, whether expressed or implied and shall not be modified by any agent, employee, representative or distributor of A.D.L. Dental Lab 
5. No warranty for immediate dentures for cracks, broken or ill-fitting dentures)

A.D.L. DENTAL LAB LABORATORY WORKING TIME 
AS INDICATED IN PRICE LIST (Please add shipping time)

SHIPPING

All Shipping Prices are based on using our Shipping Account Number and Shipping Labels only. If you use any other account or shipping carrier and method, we are not responsible for any price guarantee for shipping.

Ground Shipping: 2-4 days each way based on the shipping Zone Next Day Air Shipping: 1 Business Day* (*Extra charge for shipping)

Saturday Delivery: Extra Charges will apply

These times are approximate only and A.D.L. Dental Lab is not bound thereby nor shall A.D.L. Dental Lab be liable for any shipping delays beyond its control.

SEMI-PREVIOUS/PRECIOUS METAL POLICY

The Prices for Semi Precious and Precious metal used in prosthesis are based on existing market rate and to be charged in increments of 0.1 gram of alloy weight. In addition to Metal charges, cast labor charge will apply. The price of Semi Precious and Precious metal has a tendency to fluctuate. SEMI-PRECIOUS AND PRECIOUS METAL CHARGES ARE SUBJECT TO CHANGE AS MARKET FLUCTUATES.

HANDLIN CASE FROM YOUR OFFICE

✓ Please disinfect the impression before shipping 
✓ We do not accept un-poured alginate impression 
✓ Please check impression for void and margin integrity before shipping 
✓ We recommend use of solid tray over triple tray impression 
✓ Do not use triple tray for bridgework. We recommend full Arch solid tray impression for Bridgework or for multiple unites of crown and bridges
✓ Must include proper Bite registration with every case

LAB Rx

We need a completed Rx including office address, doctor's name, patient name, and shade if applicable

Delay in completion and delivery of a case may occur if Rx has not been filled in properly

LAB COMMUNICATION

✓ Please use our web-based software to communicate with us. 
✓ Provide and update Doctors' direct contact number, cell phone, e-mail 
✓ Call us on (215) 390-3326, if you have any question

Instructions for Use

Download and complete the RX form by hand
Include all necessary case details, materials, and turnaround time
For immediate assistance, call us at: (215) 390-3326

Call Us

Emergency RX

Fast Access When You Need It Most

📝 Download Emergency RX Form

Instructions for Use

Questions or custom needs? Don’t hesitate to reach out.
We’re here to help you deliver when it matters most.

Call Us

Emergency RX

Fast Access When You Need It Most

📝 Download Emergency RX Form

Instructions for Use

Questions or custom needs? Don’t hesitate to reach out.We’re here to help you deliver when it matters most.

Questions or custom needs? Don’t hesitate to reach out.
We’re here to help you deliver when it matters most.