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Patient Survey

CBCT Referral

    PATIENT DETAILS



    Tick possibility of Pregnancy

    We will send a booking confirmation to this email address.

    DENTIST DETAILS


    We will send a sms for booking info and scans uploading to this phone number.

    SCAN DETAILS

    Scan Type*

    Format of Scan*


    What format would you like your scan to be returned to you in?

    Option for Additional Intra Oral Scan From £50 for Single Jaw and £100 fro Dual Jaw


    Tick this box if you would like us to carry out an additional Intra Oral scan (digital impression) you may want this if you are looking to create a 3D printed drilling guide.

    Scatter Reduction


    Tick this box if there is a chance of metal or zirconia within the area of the scan. We can set up the scanner to reduce these artefacts.

    Radiology Report


    To comply with IRMER 2000 regulations radiographs and CT scans should be reviewed by the referring practitioner or by a radiologist. This can rule out the possibility of coincidental pathology. We recommend this service and are happy to offer a report via a Consultant Radiologist. A charge of £99 will be made for this service in addition to the scan.

    Radiology Report Payment*


    You must enter the exact region that the dentist has referred the patient for. Do not make a booking unless that has been confirmed.

    APPOINTMENT BOOKING

    If the patient is with you, you can book an appointment now. Alternatively, we can contact the patient for you and arrange an appointment with them.

    Would you like to book an appointment now?*


     

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