CBCT & OPG Referral Form

Please fill out the short patient referral form below

Referral Form
Home/CBCT & OPG Referral Form

Costs

Referral Scan Price
OPG £30.00
CT Scan £150.00

(Please use the form below to send us the details of your patient and what your requirements are. A member of the team will acknowledge receipt of your referral)

Referral Form

Referring Dentist Details

Patient Details

Radiograph Required

Area of interest

If no teeth are selected the whole jaw will be scanned

How would you like image to be sent?

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