Please take your time to fill in the online CBCT-OPG referral form below, download a printable version or pop in to see us and collect a referral pack. Which ever is most convenient for you.

Referred by





Patient details






Possibility of pregnancy:

Payment

Examination required


Region of interest

Full arch - please specify:

Delivery options

For the following options, please specify on diagram:

Note: It is the referring practitioners’ responsibility to ensure that all scans and radiographs are reviewed and reported appropriately in clinical records, in compliance with IR(ME)R regulations. The clinician at Alan Wilson Dentistry will take the scan with the lowest dose, smallest field of vision and best resolution, according to the area of interest and clinical indications, in line with IR(ME)R and ALARP. Age, anatomy and physical build of the patient are all dependent factors.
captcha