CBCT Referral Form

Please complete the form below and we will contact the patient as soon as possible:

 

Referring Dentist Details
Reason for Scan
Patient Details
Relevant Medical History
Area of Interest
Special Instructions
Reporting

To comply with IRMER 2000 regulations radiographs and CT scans should be reviewed by the referring practitioner or by a radiologist. This rule can rule out the possibility of coincidental pathology. We recommend this service and are happy to offer a report via a Consultant Radiologist.

By not ticking this box I am happy to make my own arrangements.

13/02/2025
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