CBCT Referral Form

    Referring Dentist Details

    Patient Details

    Please select which services you require for this Patient

    The Radiographer will take a scan with the lowest dose, smallest field of view and best resolution, according to the area of interest and clinical indications, in line with IR(ME)R and ALARP. The age, anatomy and physical build of the patient are all dependent factors.

    CBCT Scans

    Indicate Teeeth and Area of Interest

    Select Teeth

    If no area is selected the whole jaw will be scanned

    CBCT Format

    Please note that we only provide DICOM files for the CBCT

    CBCT Output

    You will receive e-mails with notifications when results are ready.
    You can also choose an additional output format, from the following options:

    Justification for X-Ray