CBCT Referrals - Finn Dental Specialists

For Dentists

Dental imaging referral form

Please complete the online form below.

Referring dentist’s details

Name

Practice name

Telephone

Email

Address

Patient details

Name

Address

Phone Number

Email address

Date of birth

Gender

Possibility of pregnancy?

Relevant medical history

Requirements

Examination required

Digital Panoramic / OPG

CBCT 1 Jaw

CBCT 2 Jaws

CBCT Sectional

Justification

Region of interest

Upper jaw

Lower jaw

Does the patient have radiological stent?

Software Options for Cone Beam CT Scans

DICOM files

Vatech Viewer Software

Cone Beam delivery options

Download via Dropbox

File sent via post on USB stick

Finn Dental Specialists does not routinely report on scans. To comply with the IRMER 2000 regulations all scans are required to be reviewed and reported into clinical notes by the referring practitioner or by a radiologist. Finn Dental Specialists strongly recommends that all CBCT scans should be reported upon.

I will make my own reporting arrangements.

I require Finn Dental Specialists to forward the scan to a dental radiologist for a report.

Pricing

Digital Panoramic (OPG)
with radiological report	£149
without report	£65

Sectional
with radiological report	£195
without report	£145

Single jaw
with radiological report	£195
without report	£159

Two jaws
with radiological report	£295
without report	£215

Referral sent!

Thank you for your referral. A member of our team will contact you shortly.

If you require any help using this form, please contact us — 020 8658 1230