CBCT Referral Form

Refer a patient for an OPT or CBCT scan.

Refer A Patient for OPT or CBCT scan.

To make a referral, please use this form. If you have any questions, please get in touch with us.


Cost for Patients:

OPT £75.00
CBCT £150.00
I hereby authorise the Private Dental Centre to carry out an OPT/CBCT on my behalf.
I have obtained consent from the patient to share their personal data via non-encrypted email, in line with GDPR data security.
The result of the radiograph will be returned via email. I am responsible for assessing the data and referring to the necessary specialities as clinically indicated. The Private Dental Centre and the operator will not be responsible for assessing the OPT for the suitability of treatment or for immediately identifying and referring pathology; by referring this patient I am accepting this responsibility.
I certify that I have obtained the necessary qualifications in order to refer and evaluate the data requested by me and provided by The Private Dental Centre.
The results of all CBCT scans will be assessed by a qualified practitioner at The Private Dental Centre and a report shall be returned via email along with the scan and the viewing software.