DIGITAL PANORAMIC REFERRAL DETAILS


CBCT EXAMINATION REFERRAL DETAILS


PATIENT DETAILS

Address

MEDICAL HISTORY


REFERRING DENTIST'S DETAILS

Address

PURPOSE & PROPOSED COURSE OF TREATMENT


IRMER 2000 Regulations: We do not routinely report on scans or radiographs. To comply with the IRMER 2000 Regulations all radiographs and scans are required to be reviewed and reported into the clinical notes by the referring practitioner or by a radiologist. We can arrange for a report to be prepared by a Consultant Radiologist if this is requested by you.

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