Thank you for putting your trust in Ziemek Laboratories to provide you with the highest quality restorations for your patients. To ensure a smooth transition, please take a moment to provide us with the following information. The information requested is required to establish your profile in our system. NOTE: Your case will remain on hold until we receive this completed information so please submit promptly to ensure timely delivery of your case and avoid the need to re-schedule. We respect our customers’ privacy and do not share your personal information with any third party. If you have any questions, please contact our lab toll-free at 1.866.943.6357. Thank you again for the opportunity to serve you and welcome to Ziemek Laboratories!