CBCT Referral

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Home
About
- Meet our Team
- Fee Guide
Treatments
Contact
Blog
Dentists Area
- Referrals
- Courses
- News

Digital Radiography Referral Form

* Indicates required field

Referring Dentists Name *

Practice Name *

Telephone *

Email *

Type of Scan *

Patient Email *

Patient Name *

Patient Address *

Line 1

Line 2

City

State

Zip Code

Country

Patient Telephone *

Select Teeth/Area to be Viewed

18 48

17 47

16 46

15 45

14 44

13 43

12 42

11 41

21 31

22 32

23 33

24 34

25 35

26 36

27 37

28 38

Justification *

I have advised my patient of the following fees (payable at the time of the scan): *

Scan without report £160 5.5 x 5 Scan with Report £220 8 x 8 Scan with Report £240

Format Required *

How would you like to receive the scan? *

Reporting *

How did you hear about us? *

Please Note
To comply with IMER 2000 & IRR 2018 regulations all radiographs and scans must be reviewed and reported into the clinical records by the referring practitioner or by an appropriately trained individual. We strongly recommend that all scans and other radiographic examinations should be reported upon to rule out the possibility of coincidental pathology.
If the referring practitioner prefers that they make their own arrangements for the reporting, please let us know in advance.

Submit

Bath Spa Dentistry
19a James Street West, Bath, BA1 2BT
Tel: 01225 464346

Opening Hours:
Monday: 09:00 - 17:00
Tuesday: 09:00 - 18:00
Wednesday: 08:00 - 17:00
Thursday: 09:00 - 17:00
Friday: 08:30 - 14:00

Regulated by Care Quality Commision, General Dental Council & Financial Conduct Authority

Bath Spa Dentistry Ltd is a registered company in England & Wales, registration number 06919668

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