Scan referrals

Dentists, if you would like to refer your patient to us for an OPG or CBCT scan, please complete and submit the online form below.

If you are referring your patient for Periodontic, Endodontic or Implants assessment or treatment, please click here.

Please supply as much information as possible. If you have any questions or difficulty using this form, please call or email us.

Patient details:

* required fields

Referring dentist details:

Reasons for referral:


Justification for scan

General Dentistry
Impacted Teeth
Periodontal Assessment
Sinus Graft
Oral Pathology


Indicate area of interest

Both jaws

Radiographs and documents:

If you would like to include radiographs, photographs or text files with your referral, you may use the file upload facility below.

Send form

Please type the code into the box below then click 'Submit'.
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