Denture Repair Packing Slip

Download and print the packing slip PDF to include with your denture shipment.

Fill Out the Packing Slip Online

Use the form below if you would rather complete the packing slip on your phone or computer. When you tap the button at the bottom, your iPhone, Android, or computer email app will open with everything filled in for you.

Packing Slip Reference Number

MMDR-

Please write this number on your package or include it inside the box so we can match your denture to your form.

Client Name

Phone Number

Address

Date

Type of Denture (Upper/Lower/Both)

Describe Issue / Break

Time of Break

Any Prior Repairs

Allergies or Sensitivities

Preferred Contact Method

Your Email (required) Required so we can match your packing slip and reply to you easily.

Consent & Liability Acknowledgment

Client Signature Type your full name.

After you tap the button, your email app should open with your packing slip already filled in. Then just press send.

Mid Michigan Denture Repair
PO Box 171
899 W Houghton Lake Dr
Prudenville, MI 48651