Assisted Living

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Assisted Care Request Form:

Case ID Number From Shipping Box (optional)
Patient Name*
First Last
Patient or Contact Person Email*
Patient or Contact Person Phone*
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How would you like your free quote:
- Phone
- Email
- Text Message (your carrier rates may apply)
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Desired Repairs or Services (select all that apply)
- Denture Repair
- Partial Repair
- Denture Cleaning
- Tooth Repair
- Other
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Repair Quote
- Replace Tooth (tooth missing)
- Tooth Fell Out (tooth provided)
- Fractured Denture or Acrylic Partial/Flipper (one fracture)
- Fractured Denture or Acrylic Partial/Flipper (mulitple)
- Cleaning
Briefly describe what is wrong with the denture:*
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Denture Delivery Method:
- Standard pre-paid shipping label already on shipping box.
- I need my repair faster, I am requesting rush service. (Note: We will contact you ASAP with additional instructions)
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Lead Status
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Repair Status
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Payment Status
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Repair Amount
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Work Order Sent to Lab
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Rx Slip Submitted
Pickup Address
Street Address Address Line 2 City State ZIP Code
Apartment or Suite Number
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Denture Delivery Method:
- Standard pre-paid shipping label already on shipping box.
- I need my repair faster, I am requesting rush service. (Note: We will contact you ASAP with additional instructions)
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Payment Method
Discounted Repair Price:
$0.00
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Broken Dentures?

We Can Fix Them!

Recent Reviews

5

Rated 5 out of 5

5 out of 5 stars (based on 64 reviews)

Excellent95%

Very good5%

Average0%

Poor0%

Terrible0%

Great service

Rated 5 out of 5

01/09/2022

Easy and convenient service. Thank You

Brian

nice job

Rated 5 out of 5

01/09/2022

the broken one feels great Just have to get use to the new one.
I hope I can eat a bagel
Thankyou if anyone needs help I will give your info

frances

Thanks

Rated 5 out of 5

01/09/2022

everything is working well
Thankyou

frances

A life saver!

Rated 5 out of 5

01/09/2022

On a two week vacation. Visiting a new city for only a few days. I figured I was stuck with broken dentures until I got home. But, with great 24 hour turn around I was able to enjoy the remainder of my vacation.

Gary

Professional and Prompt Service

Rated 5 out of 5

12/13/2021

I had two teeth missing from my denture. After receiving the prepaid UPS label, I packed the denture in bubble wrap and sent to Dental Rescue. All my questions were answered promptly and professionally. The customer service is outstanding. I received the repaired denture back in a timely manner. The repair was excellent.

Jessie

View All Reviews

Copyright Denture Rescue 2021 | The Denture Rescue Mission: In today’s day and age a physical dental visit may not be an option for many people. We use actual dentists to virtually assess the status of your damaged denture. Next our convenient contact free drop off locations make delivering your denture simple. Finally our amazing lab turn around times will have you back to living and eating normally. Terms and Conditions Thank you for becoming a client of Denture Rescue and our Associated Dental Groups. Our goal is your complete satisfaction. Please carefully read the following paragraphs. Your payment implies that you agree to our terms and conditions. If we cannot complete your repair for any reason we will provide a full refund minus any shipping costs at our option. Shipping turnaround times are based on data provided by a number of courier services. Times should be accurate but due to unforeseen circumstances extended time may occasionally be required to complete repair and/or delivery. Denture Rescue is not responsible for shipping errors made by third party shipping companies. We are not examining your mouth. You understand that a doctor has not examined your mouth (oral cavity) to check for any physical anomalies or disease. We recommend that you have your oral cavity examined in person by Dentist or Physician at least once per year. Our purpose is solely to repair your existing denture. No repairs will be undertaken until a doctor reviews the denture or images of your denture. After your denture has been reviewed by a doctor the method of repair may change from your initial request. You will be notified of any changes before the repair is started. By using our service, you agree that upon needing a denture repair it would not be REASONABLE to wait any longer and/or that a physical dental office visit would also not have been REASONABLE given your situation due to the inability to travel etc. You understand that a licensed dentist will or has reviewed the case either by examining the appliance in person, in pictures, or by video. Additionally, this was the fastest most convenient option you were able to find. If you did not use our service to repair the denture in the best/fastest/most convenient possible manner, more harm (eating, smiling, socially) would have been encountered than by not using our service. Due to the nature of repairs we cannot warranty the repair, however if we cannot complete your repair for any reason we offer a full money back guarantee minus any shipping costs. If we cannot complete your repair for any reason we will provide a full refund minus any shipping costs. Your info is protected, and it will only be used by us and our partner dentists and denture repair centers. The legally required telephone consumer protection act disclaimer: By clicking "Continue", you consent for Denture Rescue and partners to use automated technology, including auto-dialed or pre-recorded calls, emails, and SMS or MMS text messages, to contact you at the number you provided. This includes if the number is currently on any Do Not Call Lists.

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