Instrument Sharpening

Instrument Sharpening Ticket

A copy of your completed form will be emailed to you. Please be sure to print 2 copies of the form results. Include one copy with your shipment and keep the other copy for your records.

Please type your TICKET NUMBER here. Your ticket number is today's date and the last four digits of your practice phone number (YY-MMDD-####)*

Practice Name*

Contact Name*

Email*

Practice Phone Number*

Street Address*

City*

Postal Code*

Province

Number of Luxators/Elevators I am sending*

Number of Scalers/Curettes I am sending*

Number of Periosteal Elevators I am sending*

Number of Scissors I am sending

Number of Root Tip Picks I am sending*

Number of Bone Curettes I am sending*

Number of Other instruments I am sending*

Please note any concerns (if any) regarding your instruments. **Scissors and tungsten-carbide needle drivers are sent to Cislak for sharpening and retipping. Please allow 8 weeks for their completion. For retipping of tungsten-carbide needle drivers please create an instrument repair ticket.

I understand that my completed form will be emailed to me and that I must print 2 copies of my form results, one to include with my shipment and one for my records.*