Request a Local Case Pickup
Please complete this form to request a case to be picked up by our local courier.
Please indicate the name of the prescribing dentist who is sending the case.
Your Full Name
Please enter your name so that we may contact you in the event of any questions.
Enter the date when you would like the case to be picked up.
AM Pickups must be requested before 5:00pm on the prior day. PM Pickups must be requested before 12:30pm.
Enter the route when you would like the case to be picked up. AM is between 8AM-12PM and PM is between 1PM-5PM.
Enter any general comments or notes about the pickup. Please note that we are not able to schedule a specific time for pickup.
Send me a copy of my responses
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