We will always respond to referral forms we receive within 24 hours of receipt.
If you do not receive confirmation within this time then please contact us on 01747 898 303
Referring Doctor’s Details
Scan Details – (High resolution exposures for very limited fields or endodontic scanning only)
Region to scanMandibleMaxillaQuadrant Only (State Desired Quadrant in Clinical Presentation)
Is a radiographic stent to be worn?YesNo
Treatment PlannedImplant PlacementOral SurgeryEndodontic TherapyOther