CBCT Scan Referral Form

The Row Dental is a specialist dental practice that accepts referrals from dental practitioners.

    CBT Scan Request Form

    Step 1. Patient Details

    Step 2 - Referring Dentist's Details

    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 of Dental Cone Beam CT Equipment. (Click to read guidance notes)

    Step 3 - Scan Details / Region of Interest

    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.

    Step 4 - Costs

    Standard CT Scan (includes free viewing software or email) (Suitable for Nobelguide if you have the Nobelguide software)

    DeliveryCBCT will be sent via email

    Reporting of Scans

    Dentist Declaration

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