call us now on 01622 751553

call us now on 01622 751553


Radiograph referral form

If you have any queries then please do not hesitate to contact us on 01622 751553

  • Practice Details

  • Patient Details

  • DD slash MM slash YYYY
  • 3D CBCT area of interest

  • Justification for scan (IRMER 2000):

  • To be completed by the referring practitioner:

    This will act as the practitioner’s electronic signature: I hereby authorize The Implant Experts to carry out a 3D CBCT on my behalf. When scanning guides are used, these guides will be prepared in advance by the referring dentist and given to the patient to bring to the scan appointment. The results of the scan will be returned on disc with basic viewer software. Although an evaluation of the scan will be carried out and a report supplied, I am responsible for assessing the data and referring to the necessary specialties as clinically indicated. The Implant Experts and the Operator will not be responsible for assessing the scan for the suitability of treatment or for ultimately identifying and referring pathology; by referring the patient I am accepting this responsibility. The HPA CRCE-010 guidelines suggest that attendance of a CBCT Training Certificate Course is deemed a regulatory requirement for all users of CBCT systems, including those who are simply referring patients for acquisition of a CBCT image. I accept that it is my responsibility to obtain the necessary qualification in order to refer and evaluate the data requested by me and provided by The Implant Experts. Alternatively I will arrange for a Consultant Radiologist to rule out coincidental pathology.

  • Please select one of the following:
  • We'll keep in touch with you regarding any courses and events we may hold, which we think you will find useful.

    Your information will be treated in accordance with our Privacy & Cookie Policy

Reporting & scanning fees

Reporting fees:

£60 – Small /single tooth
£75 – Medium/ quadrant
£120 – Large volume full arch 

Scanning fees:

£200 – Both arches
£120 – Single arch (maxilla or mandible)
£120 – Smaller field of view where suitable 5×5 cm
£45 – OPG 


01622 751553

3 Ashford Road
ME14 5BJ

The Implant Experts



Opening hours:

Monday - Friday 08.45 - 17.15