Make an referral

I’m a patient

I’m a dentist


Patient details




Reason for referral

Further details





Digital X-ray file

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Referring GDP details



Patient details




Reason for referral

Further details





Digital X-ray file

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Make an imaging referral

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.
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