CBCT-scans

Panoral / CBCT Scan Referral Form

    Referrer Details

  • Patient Details

    • Possibility of Pregnancy:

  • Fees – The fee is payable by the patient at the time of the scan

    • Panoral (Please tick which image is required) – £50

    • CBCT (Please tick which image is required) – £ 150

    • Delivery Options:

  • I’d like to be informed of exclusive offers and other practice information YES

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