CT Scan Referral form

CT Scans

Dental Cone Beam CT Scan Request Form
  • Patient Details

  • Referring Dentist Details

  • CT Scan details

    All scans will be parallel to the occlusal plane unless otherwise specified.
  • CT Scan Charges

    Single arch = £150
    Both arches = £250
  • This field is for validation purposes and should be left unchanged.