CBCT referral form

CBCT referral form

CBCT referral form

Please use the below form to refer for CBCT.
Please note the CBCT referral platform is for GDPs only that hold a level 1 CBCT cert.

    Patient details
    Referrer's details
    CBT image area
    MandibleMaxillaBoth Jaws
    Please note: If no teeth selected then whole jaw will be scanned
    Reporting
    *Important Notice: Only UK based referrals are accepted and no self-referrals can be made for a CBCT scan.