SIMPLY COMPLETE THE FORM BELOW TO SUBMIT YOUR CBCT REFERRAL.

REFERRING DENTIST DETAILS

PATIENT DETAILS

CBCT DETAILS

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In accordance with IR(ME)R 2000 a clinical justification must be provided for each dental CBCT scan and the scan must be clinically evaluated by someone trained in the analysis of dental CBCT scans.

Note: we are able to recommend the services of a specialist in Oral and Maxillofacial radiology should you wish to arrange a radiographic report. Please visit

https://www.jm-radiology.co.uk for more information.

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Your scan will be shared with you using  our secure imaging server ‘360cloud’ which is fully GDPR compliant.

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