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CBCT Referrals

We welcome dental implant referrals as well as CBCT scan referrals from other practices. We adhere strictly to professional ethics. Patients referred to our practice would be treated only as per the referral request. For all other treatments (not mentioned on the referral form), patients have to consult their dentist.

Patient's Details

Patient's First Name

Patient's Email Address

Patient's Surname

Patient's Phone Number

Patient's Postcode

Patient's Date of Birth

Patient's Address

Referring Dentist's Details

Name of Dentist

Dentist's Clinic Address

Dentist's Phone Number

Dentist's Clinic Postcode

Dentist's Email Address

Site of Interest

Please tick relevant boxes

Maxilla

Mandible

Maxilla and Mandible

Small FoV

Alerts (e.g. Pregnancy)

Medical History

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