CBCT Referral

Please fill out the form below.

  • Referring Dentist Details

  • Patient Details

  • DD slash MM slash YYYY
  • Scan Details

  • PLEASE SPECIFY TEETH/AREAS TO BE SCANNED
  • 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.