CBCT referrals

We have recently had a CT scanner installed at the practice. This means we are now able to treat and diagnose all patients effectively and efficiently.

 

We can now offer this service to our referring dentists. If you would like to refer your patients to us for CT scans or DPT’s, please fill out the referral form.

dental clinic

Patient’s Details

First Name of patient *

Surname of patient *

Gender of patient *

MaleFemale

Date of birth of patient *

Address *

Contact Number *

Possibility of pregnancy? *

YesNo

Referred by

First name *

Surname *

E-mail address *

Address *

Contact number *

Payment

Patient to payDentist to pay

Patient history and treatment required

What examination is required?

Digital Panoramic £60Digital CephalometricWith tracing reportCone Beam CT £100My patient will wear a stentOptical scanModelWax-up

Clinical indication why scan will be taken *

Region of interest

Lower jawUpper jawWhole jawSmall volume (please tick teeth below)
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Patient history and treatment required

Report *

5x5 £858x8 £125None

Delivery options *

CDDICOMNone

Questions to radiologist (if applicable)

IRMER 2000 Regulations: UK Dental Specialists does not report upon scans or radiographs. To comply with the IRMER 2000 regulations all radiographs and scans are required to be reviewed and reported into the clinical notes by the referring practitioner or by a radiologist. UK Dental Specialists strongly recommends that all CT and other radiographic examinations should be reported upon to rule out the possibility of coincidental pathology. UK Dental Specialists offers a reporting service by a Consultant Radiologist.

Please tick one of the following:

I have added my patient’s medical history in the notes above for this radiographic examination to be reported upon by JM Radiology. The service will be provided by Dr J Makdissi, Consultant in Dental and Maxillofacial Radiology.I will make my own arrangement for the reporting of my Cone Beam CT scans acquired at UK Dental Specialists. This will be done by someone adequately trained as per HPA-CRCE-010-Guidance on the safe use of Dental Cone Beam CTI will report my Cone Beam CT scans acquired at UK Dental Specialists. I confirm that I am adequately trained to interpret cone beam CT scans as per HPA-CRCE-010-Guidance on the safe use of Dental Cone Beam CT. I will ensure that my training remains