Contact us

toothgeekds@gmail.com
916-337-4387

5620 Black Willow St, Rocklin,
CA 95677

Name

First Name

Last Name

Email

Phone

Country

(###)

###

####

Message

Fillable lab slip

Doctor

Date

MM

DD

YYYY

Phone

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Patient Name

Return Date

MM

DD

YYYY

Tooth #’s

Instructions

Translucency

Texture

Shade notes:

Gingival

Midbody

Incisal

Prep Shade

License#

Visit us

5620 Black Willow St, Rocklin, CA 95677

Hours
Monday–Friday
10am–6pm

Phone
916-337-4387