Lab IOS Lead Referral Form (All shaded areas are required entries) Email to: lableads@henryschein.co.uk Lab Name: HS Account Number: Lab Contact Person: IOS Preference: Trios3 / Trios4 / POD / Move+
Practice Name: Practice Address: Line -1 Line -2 City
Restorative Workflow (delete as required)
Postcode
Crown & Bridge Implant
Phone Number:
Denture
Email:
Aligners / Orthodontic Other?
Best Contact Person: Agreed to be Contacted Yes / No
Current IOS user / experience?
Best Method of Contact: Phone / Email Other:
Notes / Additional Comments / Info: