Patient Details

      Please complete the following details:

      • Referring Dentist Details

      Please complete the following details:

      • To comply with the IR(ME)R 2000 regulations, all radiographs and CBCT scans are required to be justified, reviewed and reported into the clinical notes by the referring practitioner or by a radiologist. We are unable to provide a report for your requested radiographs and CBCT images unless you request one. We strongly recommend that all CBCT and other radiographic examinations are reported upon to rule out the possibility of coincidental pathology, and can arrange to provide a report for your requested images for an additional fee of £85 per image.

    • You would like us to arrange for this patient’s radiographic examination(s) to be reported upon (£85 per image) (This report will be sent to you separately)

      You are adequately trained and competent to interpret and report your own CBCT images.

      • Imaging Details

      Please complete the following details:

    • 18
      17
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      11

    • 21
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      28

    • 48
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      41

    • 31
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      38

      • Image Required

      What type of image do you require?

      Yes

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