Call us now on 0131 662 4882[email protected]Book Appointment OnlineImage Required - Digital Panoramic or CBCT Step 1 - Patient Details Patient's Name * Patient's Address * Patient's Date of Birth * Patient's Phone * Patient's Email * Patient's doctor or GP Step 2 - Referring Dentist's Details Name of Dentist * Dentist's Phone * Dentist's Address * Dentist's Email * Dentist's GDC Number * Confirmation of Irmer Referrer Training * YesNo I have undertaken training required to satisfy the minimum criteria as an Irmer Referrer / Conebeam CT which is covered on pages 49, 50 and 51 of the Guidance of Safe Use of Dental Cone Beam CT (Computed Tomography) Equipment prepared by the HPA Working Party on Dental Cone Beam CT Equipment. (Click to read guidance notes) Step 3 - Scan Details /Region of Interest Region to be scanned Small Volume (sectional Scan 4-5 teeth)MandibleMaxillaeBoth Patient to wear stent provided by dentist? * YesNo In accordance with IR(ME)R 2000 a clinical justification must be provided for each dental CBCT scan and the scan must be clinically evaluated by someone trained in the analysis of dental CBCT scans. Reason for Referral and Justification for the scan * Special Instructions to IRMER operator involved in scan acquisition * Images will be reviewed and findings recorded by an IRMER operator (reporter) either —Please choose an option—MeOther - state name below If other Step 4 - Costs Please select services required* Standard CT Scan (includes free viewing software on email) Dental CBCT Scan for small volume or single jaw: £100Dental CBCT Scan for both jaws: £200OPG Digital Panoramic: £45 Delivery CBCT will be sent via email. File Attachments Please include any relevant file attachment such as radiographs, clinical notes or photographs. We accept the following files: JPG, PNG, DOC, DOCX, PDF Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 32 MB. Any Additional Comments * required fields
