Referrals

CBCT Scan and
X‑Ray Referrals

Advanced Dental Imaging Referral Service in West Hampstead

Our referral service connects dentists and healthcare professionals to advanced dental imaging in West Hampstead.
In addition, we provide CBCT scans, panoramic OPGs, and digital X-rays with excellent clarity.
Furthermore, we offer quick appointments to minimise waiting times for patients.
As a result, practitioners receive precise imaging that supports accurate diagnoses and treatment planning.
We also ensure secure digital delivery of all results for your convenience.
This allows you to access essential diagnostic information for implants, orthodontics, oral surgery, and complex care.
Most importantly, every referral is managed professionally and according to FGDP and Public Health England guidelines.

Full name

First name *

Last name *

Contact number

Contact number *

E-mail address

E-mail address *

Address

Country *

Postal code *

City *

Street address *

Street address line 2

GDC number

GDC number *

Patient title

Patient title *

Full name

First name *

Last name *

Gender

Female

Male

Date of birth

Date of birth *

Contact number

Contact number *

Address

Country *

Postal code *

City *

Street address *

Street address line 2

None

Patient to pay

Account to referrer

CBCT scan

Digital Cephalometric X-ray

Digital OPG X-ray

Will the patient be wearing a radiographic stent?

Yes

N/A

Purpose

If planning implants please list the expected teeth/sites. If not planning implants please write ‘N/A’

Upper Jaw

Lower Jaw

Upper & Lower Jaw

Small Volume (FOV 5×5 cm)

High resolution small FOV (Endodontics only)

Upper left

Lower left

Upper right

Lower right

Training Declaration *

I declare that I have received training for CBCT referrers in accordance with the current UK guidelines (Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. 2nd Edition. FGDP(UK) & PHE 2020)

Referrals

Referring Dentist Details

Referring Dentist Details

Patient details

Delivery Options

Payment

Examination required

What CBCT field of View (FOV) would you like?

Notes